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631 Evaluation of the Efficacy of Interventions on the Colonization by Acinetobacter spp. and Carbapenem-resistant Pseudomonas aeruginosa in an Intensive Care Unit: the Role of Colonization Pressure

Sunday, April 3, 2011: 3:15 PM
Coronado A (Hilton Anatole)
Mirian F. Dalben, MD , Universidade de São Paulo, São Paulo, Brazil
Cristiana M. Toscano, MD, phd , Universidade Federal de Goias, Goiania, Brazil
Mariusa Basso , Universidade de São Paulo, São Paulo, Brazil
Silvia F. Costa, MD, phd , Universidade de São Paulo, São Paulo, Brazil
Cilmara P. Garcia, MD , Universidade de São Paulo, São Paulo, Brazil
Maura S. Oliveira, MD , Universidade de São Paulo, São Paulo, Brazil
Renata D. Lobo , Universidade de São Paulo, São Paulo, Brazil
Sueli F. Raymundo , Universidade de São Paulo, São Paulo, Brazil
Cleide R. Santos , Universidade de São Paulo, São Paulo, Brazil
Anna S. Levin, MD, phd , Universidade de São Paulo, São Paulo, Brazil

Background: Infections by resistant pathogens and their transmission are major public health concern due to their related costs, morbidity and mortality.

Objective: To evaluate the efficacy of interventions on the colonization by Acinetobacter spp.(AC) and carbapenem-resistant Pseudomonas aeruginosa(CRPA) and the impact of colonization pressure (point prevalence) on the incidence of new colonizations by these pathogens.

Methods: It was a quasi-experimental study with 3 periods (pre-interventional- PI, post-educational – PE and post-alcohol hand rub implementation – PA) conducted in an ICU. In each period, patients had surveillance cultures (oropharyngeal, axillary and rectal) collected on admission, 3rd day and weekly until discharge from ICU. Every patient admitted to the ICU was elegible for the study. The outcome was to become colonized by CPRA or AC. Between PI and PE, an educational intervention focused on hand hygiene and contact precautions was conducted. By the end of PE, an intervention based on the installation of alcohol hand rub dispensers was applied. Compliance with hand hygiene and glove use was evaluated. Colonization pressure and colonization on admission to the ICU were evaluated in each period.

Results: 1)There were no differences between patients in the 3 periods 2)The educational intervention increased compliance with hand hygiene and glove use. In PA, compliance with hand hygiene and glove use decreased 3)The probability of becoming colonized by CRPA and AC during ICU stay increased over the periods. The incidence density of colonization by CPRA and AC by 1000 patient-days was 24.8 in PI, 43.3 in PE and 67.5 in PA. 4)Colonization pressure by CPRA and AC was different between periods: 14.7 in PI, 38.2 in PE and 53.3 in PA (Table1). The increase in colonization pressure through the periods was due to the admission of patients already colonized, mainly from the Emergency room (53%).

Conclusions: Control of cross transmission of AC and CPRA requires efforts to increase hand hygiene compliance but monitoring of colonization pressure appears to be important. The connection between increases in colonization pressures leading to increases in the incidence of colonization has already been shown with MRSA and VRE and our results show that it might also be true for CRPA and AC. It seems that, when colonization pressure reaches critical levels, efforts aimed at hand hygiene may not be enough to prevent transmission of pathogens and strategies may include cohort of patients and even the closure of units. In the dynamic of pathogens dissemination, infection control activity should include focusing on patients admitted to the unit and should be expanded to external sources of colonized patients.