A five-component infection control bundle to permanently eliminate a carbapenem-resistant Acinetobacter baumannii spreading in an intensive care unit

• Main Authors: Marianna Meschiari, José-María Lòpez-Lozano, Vincenzo Di Pilato, Carola Gimenez-Esparza, Elena Vecchi, Erica Bacca, Gabriella Orlando, Erica Franceschini, Mario Sarti, Monica Pecorari, Antonella Grottola, Claudia Venturelli, Stefano Busani, Lucia Serio, Massimo Girardis, Gian Maria Rossolini, Inge C. Gyssens, Dominique L. Monnet, Cristina Mussini
• Format: Article
• Language: English
• Published: BMC 2021-08-01
• Series: Antimicrobial Resistance and Infection Control
• Subjects: Carbapenem-resistant Acinetobacter baumannii; Intensive care unit; Cycling radical environmental cleaning; Infection control bundle; Whole genome sequencing analysis
• Online Access: https://doi.org/10.1186/s13756-021-00990-z

Abstract Background Carbapenem-resistant Acinetobacter baumannii (CRAB) infection outbreaks are difficult to control and sometimes require cohorting of CRAB-positive patients or temporary ward closure for environmental cleaning. We aimed at controlling the deadly 2018 CRAB outbreak in a 12 bed- intensive care unit (ICU) including 9 beds in a 220 m2 open space. We implemented a new multimodal approach without ward closure, cohorting or temporarily limiting admissions. Methods A five-component bundle was introduced in 2018 including reinforcement of hand hygiene and sample extension of screening, application of contact precautions to all patients, enhanced environmental sampling and the one-time application of a cycling radical environmental cleaning and disinfection procedure of the entire ICU. The ICU-CRAB incidence density (ID), ICU alcohol-based hand rub consumption and antibiotic use were calculated over a period of 6 years and intervention time series analysis was performed. Whole genome sequencing analysis (WGS) was done on clinical and environmental isolates in the study period. Results From January 2013, nosocomial ICU-CRAB ID decreased from 30.4 CRAB cases per 1000 patients-days to zero cases per 1000 patients-days. Our intervention showed a significant impact (-2.9 nosocomial ICU-CRAB cases per 1000 bed-days), while no influence was observed for antibiotic and alcohol-based hand rub (AHR) consumption. WGS demonstrated that CRAB strains were clonally related to an environmental reservoir which confirms the primary role of the environment in CRAB ICU spreading. Conclusion A five-component bundle of continuous hand hygiene improvement, extended sampling at screening including the environment, universal contact precautions and a novel cycling radical environmental cleaning and disinfection procedure proved to be effective for permanently eliminating CRAB spreading within the ICU. Cohorting, admission restriction or ICU closure were avoided.