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279 A Horizontal Approach for Reducing Acinetobacter Device Associated Infections

Saturday, April 2, 2011
Trinity Ballroom (Hilton Anatole)
Heather L. Albert, RN, BSN , Virginia Commonwealth University Medical Center, Richmond, VA
Diane E. Heipel, RN, BSN , Virginia Commonwealth University Medical Center, Richmond, VA
Connie Atkinson, RN , Virginia Commonwealth University Medical Center, Richmond, VA
Kakotan Sanogo , Virginia Commonwealth University Medical Center, Richmond, VA
Janis Ober , Virginia Commonwealth University Medical Center, Richmond, VA
Gonzalo Bearman, MD, MPH , Virginia Commonwealth University Medical Center, Richmond, VA
Michael P. Stevens, MD , Virginia Commonwealth University Medical Center, Richmond, VA
Michael B. Edmond, MD, MPH, MPA , Virginia Commonwealth University Medical Center, Richmond, VA

Background: Virginia Commonwealth University Health System (VCUHS) is an 840 bed academic medical center with 8 intensive care units (ICUs) comprised of 148 beds.  An increase in Acinetobacter calcoaceticus-baumanii complex device associated infections was noted in the adult ICU population in the fall of 2007.     

Objective: To describe the impact of horizontal infection control measures on the incidence of Acinetobacter device associated infections.

Methods: We employed an interrupted time series analysis to assess the impact of various interventions on Acinetobacter device associated infections. A hand hygiene surveillance program (HHSP) began in October 2007 with trained monitors performing direct observation of hand hygiene compliance. The HHSP was bundled with contact isolation (CI) of all patients colonized or infected with Acinetobacter, regardless of susceptibility.  A protocol for daily chlorhexidine bathing (CB) of all patients in the ICU began in December 2007.  Concurrent surveillance for healthcare associated device related infections has been performed via National Healthcare Safety Network (NHSN) methodology since 1998.

Results: The mean Acinetobacter device associated infection rate across all ICUs was 4.1 per 1000 patient days prior to intervention.  Following implementation of bundled HHSP and CI, Acinetobacter device associated infections decreased by 2.5 per 1000 patient days (p=0.18).  The rate of Acinetobacter device associated infections decreased by 1.8 per 1000 patient days (p=0.04) following the addition of CB of all ICU patients (figure).

Conclusions: Bundled HHSP and CI did not significantly decrease Acinetobacter device associated infections across the adult ICUs.  The addition of a CB protocol decreased Acinetobacter device associated infections.  Bundled interventions that include a HHSP, CI, and CB may be effective for the control of Acinetobacter device associated infections in adult ICUs.