Control of endemic extensively drug-resistant Acinetobacter baumannii with a cohorting policy and cleaning procedures based on the 1 room, 1 wipe approach

Gavaldà, Laura; Soriano, Ana; Càmara, Jordi; Gasull, R.; Arch, Olga; Ferrer, Montserrat; Shaw, Evelyn; Granada, R.; Domı́nguez, M.A.; Pujol, Miquel

doi:10.1016/j.ajic.2015.11.036

Cited by 22 publications

(24 citation statements)

References 24 publications

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“…One of the main actions implemented in an outbreak of extreme-drug resistant (XDR) A. baumanii in three Spanish ICUs was a revision of cleaning practices intended to avoid sharing wipes between rooms [65]. These practices also included increasing the cleaning frequency of high-touch surfaces from 3 to 6 times/day, establishing cleaning responsibilities (specifically clinical equipment), use of microfiber products and measures to ensure consistent cleaning by housekeepers.…”

Section: Cleaning Practicesmentioning

confidence: 99%

Dos and don’ts for hospital cleaning

Dancer

2016

Current Opinion in Infectious Diseases

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Purpose of review More evidence is emerging on the role of cleaning and decontamination for reducing hospital-acquired infection. Timely and adequate removal of environmental pathogens leads to measurable clinical benefits for patients. This article considers studies published from 2013 examining hospital decontamination technologies and evidence for cost-effectiveness. Recent findings Novel biocides and cleaning products, antimicrobial coatings, monitoring practices and automated equipment are widely accessible. They do not necessarily remove all environmental pathogens, however, and most have yet to be comprehensively assessed against patient outcome. Some studies are confounded by concurrent infection control and/or antimicrobial stewardship initiatives. Few contain data on costs. Summary As automated dirt removal is assumed to be superior to human effort, there is a danger that traditional cleaning methods are devalued or ignored. Fear of infection encourages use of powerful disinfectants for eliminating real or imagined pathogens in hospitals without appreciating toxicity or cost benefit. Furthermore, efficacy of these agents is compromised without prior removal of organic soil. Microbiocidal activity should be compared and contrasted against physical removal of soil in standardized and controlled studies to understand how best to manage contaminated healthcare environments.

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Section: Cleaning Practicesmentioning

confidence: 99%

Dos and don’ts for hospital cleaning

Dancer

2016

Current Opinion in Infectious Diseases

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“…The CDC recommends active microbiological surveillance for patients at high risk of colonization with resistant Gram-negative organisms and contact precautions. Cohorting, improved hand hygiene, and enhanced environmental cleaning have been successful at reducing hospital infection rates and controlling outbreaks of AB [125–127]. …”

Section: Antimicrobial Stewardship Principlesmentioning

confidence: 99%

Anticipating the Unpredictable: A Review of Antimicrobial Stewardship and Acinetobacter Infections

et al. 2017

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Acinetobacter remains one of the most challenging pathogens in the field of infectious diseases owing primarily to the uniqueness and multiplicity of its resistance mechanisms. This resistance often leads to devastatingly long delays in time to appropriate therapy and increased mortality for patients afflicted with Acinetobacter infections. Selecting appropriate empiric and definitive antibacterial therapy for Acinetobacter is further complicated by the lack of reliability in commercial antimicrobial susceptibility testing devices and limited breakpoint interpretations for available agents. Existing treatment options for infections due to Acinetobacter are limited by a lack of robust efficacy and safety data along with concerns regarding appropriate dosing, pharmacokinetic/pharmacodynamic targets, and toxicity. Antimicrobial stewardship programs are essential to combat this unpredictable pathogen through use of infection prevention, rapid diagnostics, antibiogram-optimized treatment regimens, and avoidance of overuse of antimicrobials. The drug development pipeline includes several agents with encouraging in vitro activity against Acinetobacter, but their place in therapy and contribution to the armamentarium against this pathogen remain to be defined. The objective of this review is to highlight the unique challenge of treating infections due to Acinetobacter and summarize recent literature regarding optimal antimicrobial treatment for this pathogen. The drug development pipeline is also explored for future potentially effective treatment options.

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“…24,34 Contaminated environmental sources and transmission via medical personnel may cause outbreaks of nosocomial infections. 43,66,67 Acquisition and spread of ABC has been noted in hospitals, 66 rehabilitation centers, and long-term care facilities (LTCFs), among pilgrims returning from the Hajj (Makkah) 68 and in the community (particularly among the elderly). 1,2 Colonized or infected patients, selection pressure from antimicrobial use, and incomplete compliance with infection control procedures may facilitate persistence or spread of MDR-ABC within hospital or institutional settings.…”

Section: Hospital-acquired Pneumoniamentioning

confidence: 99%

“…1,2 Colonized or infected patients, selection pressure from antimicrobial use, and incomplete compliance with infection control procedures may facilitate persistence or spread of MDR-ABC within hospital or institutional settings. 1,66 Removal or disinfection and sterilization of contaminated equipment (e.g., ventilator or nebulizer tubing) or fomites may eliminate the problem. 24,66 An outbreak of MDR-ABC in a surgical ICU was linked to aerosolization of ABC during pulsatile lavage of wounds.…”

Section: Hospital-acquired Pneumoniamentioning

confidence: 99%

Infections Due to Acinetobacter baumannii in the ICU: Treatment Options

Lynch

Zhanel

Clark

2017

Semin Respir Crit Care Med

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Bacteria within the genus (principally- complex [ABC]) are gram-negative coccobacilli that may cause nosocomial infections in critically ill or debilitated patients (particularly ventilator-associated pneumonia and infections of the bloodstream, urinary tract, and wounds). Treatment of infections is difficult, as spp. are resistant to multiple antimicrobial agents, and have a remarkable ability to via mechanisms that include plasmids, transposons, integrons, and resistance islands. Since the 1990s, global resistance to antimicrobials has escalated dramatically among ABC. Global spread of multidrug-resistant (MDR)- strains reflects dissemination of a few clones between hospitals, geographic regions, and continents; excessive use of antibiotics amplifies this spread. Many isolates are resistant to all antimicrobials except colistin (polymyxin E) and tigecycline, and some infections are untreatable with existing antimicrobial agents. Antimicrobial resistance poses a serious threat to treat or prevent infections due to ABC. Strategies to curtail environmental colonization with MDR-ABD will require aggressive infection control efforts and cohorting of infected patients. Thoughtful antibiotic strategies are essential to limit the spread of MDR-ABC. Optimal therapy will likely require combination antimicrobial therapy of existing antibiotics as well as development of novel antibiotic classes.

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Control of endemic extensively drug-resistant Acinetobacter baumannii with a cohorting policy and cleaning procedures based on the 1 room, 1 wipe approach

Cited by 22 publications

References 24 publications

Dos and don’ts for hospital cleaning

Dos and don’ts for hospital cleaning

Anticipating the Unpredictable: A Review of Antimicrobial Stewardship and Acinetobacter Infections

Infections Due to Acinetobacter baumannii in the ICU: Treatment Options

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