Effectiveness of infection prevention measures featuring advanced source control and environmental cleaning to limit transmission of extremely-drug resistant Acinetobacter baumannii in a Thai intensive care unit: An analysis before and after extensive flooding.
BACKGROUND
Advanced source control (once-daily bathing and 4-times daily oral care with chlorhexidine aqueous solution) and thorough environmental cleaning were implemented in response to an increased incidence of colonization and infection with extremely drug-resistant (XDR) Acinetobacter baumannii in a Thai medical intensive care unit (MICU).


METHODS
During the 12-month baseline period (P1), contact isolation, active surveillance for XDR A baumannii, cohorting of XDR A baumannii patients, twice-daily environmental cleaning with detergent-disinfectant, and antibiotic stewardship were implemented. In the 5.5-month intervention period (P2), additional measures were introduced. Sodium hypochlorite was substituted for detergent-disinfectant, and advanced source control was implemented. All interventions except cleaning with sodium hypochlorite were continued during the 12.5-month follow-up period (P3). Extensive flooding necessitating closure of the hospital for 2 months occurred between P2 and P3.


RESULTS
A total of 1,365 patients were studied. Compared with P1 (11.1 cases/1,000 patient-days), the rate of XDR A baumannii clinical isolates declined in P2 (1.74 cases/1,000 patient-days; P < .001) and further in P3 (0.69 cases/1,000 patient-days; P < .001). Compared with P1 (12.15 cases/1,000 patient-days), the rate of XDR A baumannii surveillance isolates also declined in P2 (2.11 cases/1,000 patient-days; P < .001) and P3 (0.98 cases/1,000 patient-days; P < .001). Incidence of nosocomial infections remained stable. Six patients developed chlorhexidine-induced rash (1.4/1,000 patient-days); 31 patients developed mucositis (17.1/1,000 patient-days).


CONCLUSIONS
These results support advanced source control and thorough environmental cleaning to limit colonization and infection with XDR A baumannii in MICUs in resource-limited settings.
Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand. Electronic address: anapisarn@yahoo.com.
Anucha
A
Apisarnthanarak
Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
Uayporn
U
Pinitchai
Department of Applied Statistics, Faculty of Science, King Mongkut's Institute of Technology, Ladkrabang, Thailand.
Boonyasit
B
Warachan
Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO.
David K
DK
Warren
Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
Thana
T
Khawcharoenporn
Division of Infectious Diseases, Rush University Medical Center, Chicago, IL.
Mary K
MK
Hayden
D000151:Acinetobacter Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification; D000328:Adult; D000368:Aged; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D004203:Disinfection / Q000379:methods*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006797:Housekeeping, Hospital / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D013785:Thailand / Q000453:epidemiology
Gram negative; Infection control; Intervention; Multidrug resistant; Resource-limited setting