Control of a Clonal Outbreak of Multidrug-Resistant Acinetobacter baumannii in a Hospital of the Basque Country after the Introduction of Environmental Cleaning Led by the Systematic Sampling from Environmental Objects.
Background. Between July 2009 and September 2010, an outbreak of multidrug-resistant (MDR) Acinetobacter baumannii was detected in one critical care unit of a tertiary hospital in the Basque Country, involving 49 infected and 16 colonized patients. The aim was to evaluate the impact of environmental cleaning and systematic sampling from environmental objects on the risk of infection by MDR A. baumannii. Methods. After systematic sampling from environmental objects and molecular typing of all new MDR A. baumannii strains from patients and environmental isolates, we analyzed the correlation (Pearson's r) between new infected cases and positive environmental samples. The risk ratio (RR) of infection was estimated with Poisson regression. Results. The risk increased significantly with the number of positive samples in common areas (RR = 1.40; 95%CI = 0.99-1.94) and positive samples in boxes (RR = 1.19; 95%CI = 1.01-1.40). The number of cases also positively correlated with positive samples in boxes (r = 0.50; P < 0.05) and common areas (r = 0.29; P = 0.18). Conclusion. Once conventional measures have failed, environmental cleaning, guided by systematic sampling from environmental objects, provided the objective risk reduction of new cases and enabled the full control of the outbreak.
Service of Preventive Medicine, University Hospital of Cruces, Basque Health Service OSAKIDETZA, 48903 Barakaldo, Bizkaia, Spain ; Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country, 48940 Leioa, Bizkaia, Spain.
Jesús
J
Delgado Naranjo
Service of Preventive Medicine, University Hospital of Cruces, Basque Health Service OSAKIDETZA, 48903 Barakaldo, Bizkaia, Spain ; Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country, 48940 Leioa, Bizkaia, Spain.
José Ignacio
JI
Villate Navarro
Laboratory of Microbiology, University Hospital of Cruces, Basque Health Service OSAKIDETZA, 48903 Barakaldo, Bizkaia, Spain.
Mercedes
M
Sota Busselo
Service of Anaesthesia and Reanimation, University Hospital of Cruces, Basque Health Service OSAKIDETZA, 48903 Barakaldo, Bizkaia, Spain.
Alberto
A
Martínez Ruíz
Service of Preventive Medicine, University Hospital of Cruces, Basque Health Service OSAKIDETZA, 48903 Barakaldo, Bizkaia, Spain ; Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country, 48940 Leioa, Bizkaia, Spain.
José María
JM
Hernández Hernández
Service of Anaesthesia and Reanimation, University Hospital of Cruces, Basque Health Service OSAKIDETZA, 48903 Barakaldo, Bizkaia, Spain.
María Pilar
MP
Torres Garmendia
Service of Preventive Medicine, University Hospital of Cruces, Basque Health Service OSAKIDETZA, 48903 Barakaldo, Bizkaia, Spain.
María Isabel
MI
Urcelay López