The effect of temporary closure and enhanced terminal disinfection using aerosolized hydrogen peroxide of an open-bay intensive care unit on the acquisition of extensively drug-resistant Acinetobacter baumannii

Abstract

Background: At Makassed Hospital's open-bay intensive care unit (ICU), enhanced terminal disinfection (ETD) using hydrogen peroxide (H 2 O 2) was performed without a predefined schedule in extensively-drug-resistant Acinetobacter baumannii (XDR-AB) outbreaks. In this study, we aimed to check for the value of the temporary closure of the ICU and the use of ETD with aerosolized H 2 O 2 and Ag + on minimizing the rate of XDR-AB acquisition in patients admitted to the ICU of our facility, which might consequently help us determine the optimal schedule for such procedure in this unit. Methods: This is a retrospective medical file review of patients admitted to the ICU between January 2016 and May 2018. We divided this period into numerical weeks (NW) after each closure and ETD episode. Risk factors of acquisition (RFA) were determined by comparing the characteristics of patients who acquired XDR-AB to those who didn't. The proportion of patients residing in each NW was included in the RFA analysis. Results: Out of 335 patients, 13% acquired XDR-AB. The overall incidence of XDR-AB acquisition was 14.6 cases/1000 patient days. RFA were XDR-AB contact pressure ≥ 3 days [Odds Ratio (OR) = 9.86, 95% Confidence Interval (CI) (3.65-26.64), P < 0.0001)], mechanical ventilation [OR = 4.99, 95%CI (1.76-14.15), P = 0.002)], and having a wound [OR = 3.72, 95%CI (0.99-13.96), P = 0.05)]. Patients who stayed during NW 7,11 and 14 were at risk of acquisition where the odds significantly increased by 6.5, 9.7 and 14.4 folds respectively (P = 0.03,0.01, and 0.01, respectively). We considered NW 7 as the most suitable time for temporary closure of the ICU and ETD with aerosolized H 2 O 2 .

Epidemiology, risk factors, and prediction score of carbapenem resistance among inpatients colonized or infected with 3rd generation cephalosporin resistant Enterobacterales

“…Active microbiological screening for patients’ colonization status and acquisition of carbapenem-resistant organisms was performed during the study period in the ICU only 47 . Specimens from the throat, axillae, urine, and perineal area were routinely cultured, in addition to sputum and/or skin lesion (aspirate/biopsy/swab) when applicable 47 . These cultures were secured upon ICU admission and on a weekly basis, as long as the patient was still there and whenever the clinical situation necessitated 47 .…”

“…Specimens from the throat, axillae, urine, and perineal area were routinely cultured, in addition to sputum and/or skin lesion (aspirate/biopsy/swab) when applicable 47 . These cultures were secured upon ICU admission and on a weekly basis, as long as the patient was still there and whenever the clinical situation necessitated 47 .…”

The Impact of Antimicrobial Stewardship and Infection Control Interventions on Acinetobacter baumannii Resistance Rates in the ICU of a Tertiary Care Center in Lebanon

“…Other reports from major Lebanese hospitals reveal the burden of CRAb on ICUs, with increased mortality and morbidity and poor patient outcomes [ 39 , 40 , 41 , 42 ]. Interventions to control CRAb in those hospitals included either infection control measures to break transmission—such as terminal cleaning of an ICU [ 43 ]—or antimicrobial stewardship efforts to decrease resistance rates [ 44 , 45 ]. Acinetobacter baumannii constitute the large majority of the Acinetobacter organisms tested in our microbiology diagnostic laboratory.…”