596 Validation of an Environmental Culturing Technique for Multi-Drug Resistant Acinetobacter baumanni

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Natalie Blum , Memorial Hermann Texas Medical Center, Houston, TX
Wiline Jean , Memorial Hermann Texas Medical Center, Houston, TX
Audrey Wanger , Memorial Hermann Texas Medical Center, Houston, TX
Mark Kruzel , Memorial Hermann Texas Medical Center, Houston, TX
Virgie Fisher , Memorial Hermann Texas Medical Center, Houston, TX
Luis Ostrosky-Zeichner , Memorial Hermann Texas Medical Center, Houston, TX
Background: Multi-Drug Resistant Acinetobacter baumanii (MDRAB), a gram-negative bacterium, is ubiquitous in the clinical environment and has become an important nosocomial pathogen associated with hospital outbreaks.  During an outbreak of MDRAB, we were consistently unable to isolate the organism from the environment.  This limited our ability to control the outbreak as we were unable to determine potential reservoirs for infection. Objective: We sought to evaluate a new culture technique using enriched media for outbreak investigations of MDRAB.
Methods: Environmental culturing was done in Intensive Care Units (ICUs), operating rooms, radiology suites, and floor units.  A vast array of environmental surfaces were cultured with BBL Culture Swabs (IVD) including monitor buttons, ventilator buttons, charts, bedrails, patient pillows, supply cabinets, X-Ray machines, operating tables, and computer keyboards in patient care areas.  The swabs were incubated in tubes of Baumann’s Enrichment Media for 48 hours at 30° C in a shaking incubator.  Swabs were then plated to Maconkey agar plates and incubated for another 48 hours at 30° C.  Plates with bacterial growth were subcultured and MDRAB was identified using the BD Phoenix automated system.
Results: A total of 176 environmental cultures were taken between the months of July and September of 2008.  Of 176 cultures, 28 (15.9%) were positive for MDRAB.  Positive surfaces included monitor buttons, ventilator buttons, supply bins, and computer keyboards.  Positive cultures were predominantly from the ICUs.  All cultures taken from the operating rooms and radiology suites were negative.

Conclusions: The use of an enrichment media for laboratory work-up of environmental cultures has become a hospital standard when culturing for MDRAB.  By using this technique to identify reservoirs, we were able to limit the spread of MDRAB throughout the hospital.  These findings led to a massive education campaign and changes to hospital cleaning protocols.