title: Reducing the spread of Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus on a burns unit through the intervention of an infection control bundle.
abstract: Methicillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter baumannii are major nosocomial pathogens in burns units. We investigated the impact of an infection control bundle on the incidence of nosocomial MRSA and A. baumannii in our burns unit, comparing a pre-intervention period (December 2006-August 2008) with an intervention period (September 2008-December 2009). The bundle comprised regular hydrogen peroxide vapour (HPV) disinfection of the rooms following discharge of patients colonized or infected by multidrug-resistant bacteria, pre-emptive cohort isolation of newly admitted patients before being proven culture negative, cohorting of colonized or infected patients, installation of two air disinfection systems in the corridors of the unit and improvement of material storage. We also investigated the microbiological efficacy of HPV disinfection by sampling the environment before and after HPV treatments. HPV disinfection eliminated pathogens from the environment and significantly reduced total bacterial surface counts, and total fungal air and surface counts, on both a unit and room scale. The incidence of nosocomial MRSA infection or colonization fell by 89.3% from 7.22 to 0.77 cases/1000 patient days (p<0.0001) and A. baumannii fell by 88.8% from 6.92 to 0.77 cases/1000 patient days (p=0.002) in the intervention period with no further outbreaks of these organisms occurring in this period. The infection control bundle resulted in a significant reduction in the incidence of nosocomial MRSA and A. baumannii in our burns unit and prevented further outbreaks of these organisms.
authors.affiliation: Saint-Antoine Hospital, Paris, France. frederic.barbut@sat.aphp.fr
authors.forename: Frédéric
authors.initials: F
authors.lastname: Barbut
authors.forename: Saber
authors.initials: S
authors.lastname: Yezli
authors.forename: Maurice
authors.initials: M
authors.lastname: Mimoun
authors.forename: Julien
authors.initials: J
authors.lastname: Pham
authors.forename: Marc
authors.initials: M
authors.lastname: Chaouat
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Otter
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology / Q000517:prevention & control*; D040981:Acinetobacter baumannii / Q000302:isolation & purification*; D002053:Burn Units / Q000706:statistics & numerical data*; D002056:Burns / Q000382:microbiology*; D003428:Cross Infection / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control; D004203:Disinfection / Q000379:methods; D005740:Gases; D006801:Humans; D006861:Hydrogen Peroxide / Q000008:administration & dosage; D017053:Infection Control / Q000379:methods*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D010297:Paris; D010356:Patient Isolation; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D005740:Gases; D006861:Hydrogen Peroxide