Reduction in MDRA Transmission in an Adult ICU via a Multifaceted Approach Including Universal Gown and Gloves

Background: Multi-drug resistant Acinetobacter baumannii (MDRA) has become a persistent problem in healthcare settings, long-term acute care facilities and intensive care units in particular. Efforts to curtail transmission among vulnerable patient populations have not always been successful due to the organism's ease of transmission to healthcare workers, environmental persistence, and ability to acquire antibiotic resistance via diverse mechanisms. Multifaceted approaches to controlling spread of this pathogen appear to be required.

Objective: To evaluate the impact of a multifaceted infection-control approach on the rate of MDRA transmission in the medical intensive care unit of an urban tertiary-care community hospital, implemented in response to an apparent outbreak.

Methods: Primary elements of the MDRA control protocol included cohorting of patients to one side of the unit, implementation of universal gown and gloving on the unit with emphasis on proper hand hygiene, daily CHG bathing of patients, cohorting of staff, and use of bleach-based environmental cleaning upon transfer or discharge of known colonized or infected patients. Results of the protocol were evaluated via comparison of transmission and mortality rates in the unit before and after the protocol was fully instituted.

Results: In the 3-month period (October-December 2009) during which the outbreak became apparent, the MDRA transmission rate in the MICU was 10.78 transmission events (8 individual cases) per 1000 patient days among patients admitted to the unit on or after 1 October, or already present on the unit as of that date, until implementation of control measures. Most of those events occurred within the last 5 weeks of the observation period. Following full implementation of control measures, the transmission rate in the unit was reduced to 0 (p = 0.008) among patients admitted over the subsequent 3-month period (January-March 2010). This reduction in the transmission rate did not have a positive effect, however, on the unit's overall observed mortality rate. Mean total patient charges were reduced by approximately $12.000 (p = 0.51); mean total length of hospitalization was reduced by approximately 1.4 days (p = 0.39); and mean ICU days were reduced by approximately 1.8 days (p = 0.19).

Conclusions: Our results indicate that a comprehensive approach to MDRA-directed infection control can have a signficant impact on the rate of transmission of this virulent organism among vulnerable patients, and possibly on overall hospital and ICU length of stay. The intervention may also have contributed to a considerable cost savings for the institution.