Emergence of Carbapenem-Resistant Acinetobacter baumannii in Nursing Homes With High Background Rates of MRSA Colonization

Abstract

Carbapenem-resistant Acinetobacter baumannii (CRAB) with diverse multilocus sequence typing emerged among our nursing home residents (6.5%) with a high background rate of MRSA (32.2%). Rectal swabs yielded a higher rate of CRAB detection than axillary or nasal swabs. Bed-bound status, use of adult diapers, and nasogastric tube were risk factors for CRAB colonization. Infect Control Hosp Epidemiol 2016;37:983-986.

Role of Hand Hygiene Ambassador and Implementation of Directly Observed Hand Hygiene Among Residents in Residential Care Homes for the Elderly in Hong Kong

“…The role of RCHEs was described previously. 2,7 Briefly, an RCHE is a long-term care facility that provides daily nursing care to residents, including the use of feeding tubes, urinary catheters, and other medical devices in Hong Kong. Community geriatric assessment teams (CGATs) comprising of a team of geriatricians, nurses, and allied health professionals provide regular on-site visits to the RCHEs to perform comprehensive medical assessments.…”

“…To establish the updated MDRO prevalence among residents and environment, research nurses who received prior training from the infection control team obtained nasal swabs, axillary swabs, rectal swabs, and environmental samples using sponge swabs according to a standard protocol as previously described. 7,16,17 Written consent forms were obtained from the participating residents. Subjects were excluded if they were not able to provide consent.…”

“…7 , 19 We did not screen for VRE and CPE because of its low prevalence in our RCHE. 7 , 20 For each sponge swab, 2mL sterile normal saline (0.85% sodium chloride) was added to the sterile plastic bag. The sponge was squeezed repeatedly for proper mixing, then 100 μL suspension was transferred from the bag for processing as previously described.…”

“…The sponge was squeezed repeatedly for proper mixing, then 100 μL suspension was transferred from the bag for processing as previously described. 7 , 19 …”

“…6 Although the hand hygiene compliance improved from 27% to 60% during the study period, the prevalence of MDROs continued to increase, especially MRSA, which has risen from 21.6% to 32.2% in our long-term care facilities. 2,7 The effect of the WHO Five Moments hand hygiene campaign was not sustained, which may be attributed to the relatively low education level of staff in our long-term care facilities, where almost 50% of the staff have an education below the secondary level. 8 …”