The “A team”: An environmental services intervention to control Multidrug-resistant Acinetobacter

Background:

An outbreak of MDRA consisting of 18 cases from June to July 2009 was identified in an ICU in a tertiary care center. Analysis showed that, despite stringent cleaning protocols using 10% bleach and checklists, some of the cases occurred in rooms previously occupied by other MDRA-infected patients.

Objective:

We sought to investigate if a protocolized double terminal clean performed by especially trained environmental services personnel was effective in reducing the number of MDRA-culture positive rooms and if this intervention would facilitate control of the outbreak.

Methods:

With the support of environmental services and hospital administrators, the “A team” was created.   “A team” members were identified as the most thorough housekeepers of every shift and they were tasked with post discharge cleaning of rooms where patients with MDRA were housed. Upon discharge, infection control notified environmental services and a sign with a lock symbol was affixed on the door of the room to block it for the duration of cleaning. Also, no furniture could be removed from the room until the lock sign was removed. The new protocol consisted of two terminal cleanings performed by separate members of the “A team”, done 45 minutes apart. After cleaning, infection control staff cultured room surfaces systematically with enriched media to validate the effectiveness of the cleaning.

Results:

When regular terminal cleaning was in place in the two weeks prior to starting the “A team” initiative, 109 items in different rooms were cultured and 17% were positive for MDRA. These accounted for 10% (week 1) and to 30% (week 2) of rooms cultured having at least one surface positive for MDRA.   In the first week of the “A team” initiative, there were a total of 123 items cultured and none grew MDRA, reducing the percentage of culture positive room to 0%. Since implementing this new cleaning protocol house-wide, there has been no documented in-house transmission of MDRA.

Conclusions:

A multidisciplinary intervention involving administration, environmental services, nursing, and infection control resulted in a reduction in MDRA contaminated surfaces and cases. Multidisciplinary/multifaceted interventions are useful in controlling MDRA transmission.