title: Evaluation of a modified cleaning procedure in the prevention of carbapenem-resistant Acinetobacter baumannii clonal spread in a burn intensive care unit using a high-sensitivity luminometer.
abstract: BACKGROUND
  Enhanced environmental cleaning practices are among the most accepted measures for controlling the spread of carbapenem-resistant Acinetobacter baumannii (CR-Ab).
  
  
  OBJECTIVE
  To evaluate the impact of heightened cleaning on an ongoing CR-Ab outbreak in a burn intensive care unit (BICU) of an Italian teaching hospital, where chlorhexidine-60% isopropyl alcohol was applied as a complementary disinfectant on high-touch surfaces.
  
  
  METHODS
  Compliance with the microbial limit proposed for the BICU by AFNOR-NF-S90-351 (20 colony-forming units/100cm2) was assessed by plate count, and compared with the results obtained with intracellular adenosine triphosphate (ATP) detection. Genotyping was performed using pulsed-field gel electrophoresis.
  
  
  RESULTS
  During the standard cleaning regimen, three out of 23 samples (13%) gave results over the AFNOR limit and five (21.7%) showed unacceptable ATP levels with 100 relative light units/100cm2as the benchmark limit (sensibility 86.4%, specificity 92.2%). Following improvement of the cleaning procedure, only two samples out of 50 (4%) did not satisfy the microbiological criteria and seven (14%) exceeded the ATP limit. In a successive phase, eight of 30 samples collected showed unacceptable results (27%).
  
  
  CONCLUSIONS
  Adding chlorhexidine-60% isopropyl alcohol as complementary disinfectant proved to be effective for reducing environmental microbial contamination, ATP levels and CR-Ab infection/colonization in patients admitted to the BICU. Real-time monitoring by ATP assay was useful for managing the cleaning schedule and reducing hospital infections, although the calculated values must be interpreted as cleanliness indicators rather than risk indicators.
authors.affiliation: Department of Translational Research, N.T.M.S., University of Pisa, Pisa, Italy. Electronic address: beatrice.casini@med.unipi.it.
authors.forename: B
authors.initials: B
authors.lastname: Casini
authors.affiliation: Department of Translational Research, N.T.M.S., University of Pisa, Pisa, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Selvi
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: M L
authors.initials: ML
authors.lastname: Cristina
authors.affiliation: Department of Translational Research, N.T.M.S., University of Pisa, Pisa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Totaro
authors.affiliation: Department of Translational Research, N.T.M.S., University of Pisa, Pisa, Italy.
authors.forename: A L
authors.initials: AL
authors.lastname: Costa
authors.affiliation: Department of Translational Research, N.T.M.S., University of Pisa, Pisa, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Valentini
authors.affiliation: Unit of Microbiology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Barnini
authors.affiliation: Department of Translational Research, N.T.M.S., University of Pisa, Pisa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Baggiani
authors.affiliation: Unit of Infectious Diseases, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Tagliaferri
authors.affiliation: Department of Translational Research, N.T.M.S., University of Pisa, Pisa, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Privitera
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000302:isolation & purification*; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002053:Burn Units; D015780:Carbapenems / Q000494:pharmacology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D004202:Disinfectants / Q000008:administration & dosage; D004203:Disinfection / Q000379:methods*; D004783:Environmental Microbiology; D019983:Guideline Adherence; D006784:Hospitals, Teaching; D006797:Housekeeping, Hospital / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D007558:Italy / Q000453:epidemiology; D008163:Luminescent Measurements / Q000379:methods*; D011786:Quality Control; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D004202:Disinfectants
keywords: ATP assay; Burn intensive care unit; Carbapenem-resistant Acinetobacter baumannii; Cleaning schedule; Pulsed-field gel electrophoresis; Surfaces