Controlling endemic Acinetobacter baumannii with sodium hypochlorite

Background: Several approaches have been taken in attempts to control Acinetobacter infection. Successful measures have been described in controlling outbreaks. However, controlling endemic Acinetobacter infection in hospital is very difficult. Objective: The aim of our study was to evaluate the effectiveness of environmental disinfection with 1% hypochlorite as an isolated measure to control endemic Acinetobacter infection and colonization in a hospital.

Methods: This study was performed in a 660-bed university hospital in Curitiba, a city in Southern Brazil. An observational prospective study was performed after establishment of a new hygienization environment using 1% hypochlorite. The normal routine to control infection remained the same during the hygiene modification. There were no other interventions, such as educational campaign or hand washing orientation. The data were collected at three distinct phases: ten months prior to the routine modification, three months during the hypochlorite application and five months after the protocol.. We included hospital pneumonia, bacteremia and urinary tract infection in analyzing the infection rate.
We analyzed the most common complaints of heath care workers using a questionnaire with objective answers at the end of the protocol to avoid behavioral modifications.

 

Results: During the first period, the rate of bacteremia was 4.6 per 1000 patient-days, the rate of urinary tract infection was 4.3 per 1000 patient-days and the rate of ventilator-associated pneumonia was 8.1 per 1000 patient-days. During the second period (during intervention), the rate of bacteremia was 1.1 per 1000 patient-days, the rate of urinary tract infection was 1.1 per 1000 patient-days and the rate of ventilator-associated pneumonia was 4.0 per 1000 patient-days (p < 0.05). During the third period (after intervention), the rate of bacteremia was 3.4 per 1000 patient-days, the rate of urinary tract infection was 12.0 per 1000 patient-days and the rate of ventilator-associated pneumonia was 6.50 per 1000 patient-days. Intervention with hypochlorite showed a significant reduction in Acinetobacter infection of all types (urinary, bacteremia and pneumonia) (p < 0.05). However, during the third period after interruption of hypochlorite usage, the infection rate was similar to the first period, which was before intervention. The rate of colonization was similar during all three periods (p > 0.05). The main complaints were conjunctival hyperemia (28.4%), followed by headache and smell (27.8 and 22.4%, respectively).

 

Conclusions: Environment hygienization with hypochlorite is effective in controlling endemic Acinetobacter infection. However, this isolated approach is not sustained and must be performed in conjunction with other measures of infection control. Adverse effects caused by hypochlorite usage are transitory and does not result in absenteeism of healthcare workers.