Control of hospital endemicity of multiple-drug-resistant Acinetobacter baumannii ST457 with directly observed hand hygiene

Abstract

An increasing endemicity of multiple-drug-resistant Acinetobacter baumannii (MRAB) ST457 was noted in Hong Kong. The epidemiology, risk factors, and infection control measures to prevent nosocomial transmission of this epidemic clone were analyzed. A total of 5,058 patients cultured positive with A. baumannii between 1 January 2004 and 30 June 2014 were included, of which 297 (5.9 %) had bacteremia. The first case of MRAB bacteremia emerged in 2009, with an incidence that increased from 0.27 (one case) in 2009 to 1.86 (14 cases) per 100,000 patient-days in 2013 (p < 0.001). With the implementation of strict contact precautions and directly observed hand hygiene in conscious patients immediately before receiving meals and medications in July 2013, the incidence of MRAB bacteremia reduced from its peak to 0.77 (one case) per 100,000 patient-days in the first 6 months of 2014 (p < 0.001). Patients from long-term care facilities for the elderly [odds ratio (OR) 18.6, confidence interval (CI) 2.1-162.4, p = 0.008] and history of carbapenem (OR 7.0, CI 1.7-28.0, p = 0.006) and beta-lactam/beta-lactamase use (OR 5.6, CI 1.1-28.7, p = 0.038) 90 days prior to admission were independent risk factors for MRAB bacteremia by logistic regression when compared with carbapenem-susceptible A. baumannii bacteremia.

Multidrug-resistant organism carriage among residents from residential care homes for the elderly in Hong Kong: a prevalence survey with stratified cluster sampling

“…Hand hygiene protocols should be followed carefully by health care workers in RCHEs, especially when handling patients' food or medication; after napkin rounds; and before and after nursing care processes. 42 Environmental hygiene measures, such as regular cleansing and disinfection of residents' immediate environment and frequently touched areas, are of similar importance. 43 The present study identified no VRE or CPE carriers from 373 stool and 654 rectal swabs of the residents screened.…”

A Novel Risk Factor Associated With Colonization by Carbapenemase-Producing Enterobacteriaceae: Use of Proton Pump Inhibitors in Addition to Antimicrobial Treatment

“…Upon identification of gastrointestinal colonization of CPE, infection control nurses would advise appropriate infection control measures as described previously. 11,[15][16][17] Briefly, patients were placed in single-room isolation with strict contact precautions. Cleaning staff was specifically trained to perform meticulous disinfection of high-touch areas, such as bedrail, bedside table, and locker.…”

Draft Genome Sequences of Two Carbapenemase-Producing Acinetobacter baumannii Clinical Strains Isolated from Albanian and Togolese Patients

“…In recent years, wide dissemination and hospital outbreaks of multidrug-resistant A. baumannii strains have been reported (3–5). Here, we report the draft genome sequences of two carbapenemase-producing A. baumannii strains, H31499 and H31506.…”