[Eradication of a nosocomial outbreak of multidrug-resistant Acinetobacter baumannii infections after adjusting nursing workloads and reinforcing specific precautions].
BACKGROUND
During 2009, an outbreak of multidrug-resistant Acinetobacter baumannii (MDR A. baumannii) infections was detected in a 27-bed intensive care unit, resulting in 25 cases being infected.


METHODS
A matched case-control study was conducted to identify risk factors for infection. The colonization pressure, or the proportion of other patients colonized by MDR A. baumannii, was estimated. TISS-28 and Omega scores of each patient were calculated to evaluate nursing work requirements. Conditional logistic regression analyses were carried out.


RESULTS
Breakdowns in hand washing and glove use were observed. Infected patients (cases) were more likely than paired controls to have had longer exposure to invasive devices and antimicrobial treatment. The independent risk factors identified by the multivariate analysis were, mechanical ventilation [odds ratio (OR)=1.03; 95% confidence interval (CI), 1.01-1.05; P=.01], and exposure to an infected or colonized patient [OR=1.7; 95%CI, 1.1-2.6; P=.02). A combined infection control strategy was implemented, including strict compliance with isolation precautions, grouping of patients, reinforcing cleaning and disinfection of surfaces, and a decrease in work load. Subsequently, a sharp reduction in the incidence MDR A. baumannii infections was shown. Therapeutic activity scores were significantly higher for cases than for controls.


CONCLUSIONS
The results suggest patient-to-patient transmission of MDR A. baumannii. Reinforcement of specific procedures and work load adjustment were essential to eradicate this outbreak.
Unidad de Control de Infecciones, Hospital Universitari de La Ribera, Alzira, Valencia, España. Electronic address: Rbou@Hospital-Ribera.com.
Ricardo
R
Bou
Sonia
S
Gomar
Fany
F
Hervás
Aurora
A
Amorós
D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000517:prevention & control*; D040981:Acinetobacter baumannii / Q000187:drug effects*; D016022:Case-Control Studies; D003428:Cross Infection / Q000517:prevention & control*; D060740:Disease Eradication; D004196:Disease Outbreaks / Q000517:prevention & control*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D017053:Infection Control / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D012307:Risk Factors; D016526:Workload
Acinetobacter baumannii; Brote; Cargas de trabajo; Cross-infection; Infecciones cruzadas; Multidrug-resistant; Multirresistente; Outbreak; Workload