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Use of Vaporized Hydrogen Peroxide Decontamination during an Outbreak of Multidrug-Resistant Acinetobacter baumannii Infection at a Long-Term Acute Care Hospital

Published online by Cambridge University Press:  02 January 2015

Amy Ray*
Affiliation:
Division of Infectious Diseases and HIV Medicine, University Hospitals Case Medical Center, Cleveland, Ohio
Federico Perez
Affiliation:
Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Amanda M. Beltramini
Affiliation:
Division of Infectious Diseases and HIV Medicine, University Hospitals Case Medical Center, Cleveland, Ohio
Marta Jakubowycz
Affiliation:
Division of Infectious Diseases and HIV Medicine, University Hospitals Case Medical Center, Cleveland, Ohio
Patricia Dimick
Affiliation:
Division of Infectious Diseases and HIV Medicine, University Hospitals Case Medical Center, Cleveland, Ohio
Michael R. Jacobs
Affiliation:
Division of Infectious Diseases and HIV Medicine, University Hospitals Case Medical Center, Cleveland, Ohio
Kathy Roman
Affiliation:
Division of Infectious Diseases and HIV Medicine, University Hospitals Case Medical Center, Cleveland, Ohio
Robert A. Bonomo
Affiliation:
Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Robert A. Salata
Affiliation:
Division of Infectious Diseases and HIV Medicine, University Hospitals Case Medical Center, Cleveland, Ohio
*
University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106-5083, (Amy.Ray@uhhospitals.org)

Abstract

Objectives.

To describe vaporized hydrogen peroxide (VHP) as an adjuvant in the control of multidrug-resistant (MDR) Acinetobacter baumannii infection in a long-term acute care hospital (LTACH) and to describe the risk factors for acquisition of MDR A. baumannii infection in the LTACH population.

Design.

Outbreak investigation, case-control study, and before-after intervention trial.

Setting.

A 54-bed LTACH affiliated with a tertiary care center in northeastern Ohio.

Methods.

Investigation of outbreak with clinical and environmental cultures, antimicrobial susceptibility testing, polymerase chain reaction assay of repetitive chromosomal elements to type strains, and case-control study; and intervention consisting of comprehensive infection control measures and VHP environmental decontamination.

Results.

Thirteen patients infected or colonized with MDR A. baumannii were identified from January 2008 through June 2008. By susceptibility testing, 10 (77%) of the 13 isolates were carbapenem-resistant. MDR A. baumannii was found in wound samples, blood, sputum, and urine. Wounds were identified as a risk factor for MDR A. baumannii colonization. Ventilator-associated pneumonia was the most common clinical syndrome caused by the pathogen, and the associated mortality was 14% (2 of the 13 case patients died). MDR A. baumannii was found in 8 of 93 environmental samples, including patient rooms and a wound care cart; environmental and clinical cultures were genetically related. Environmental cultures were negative immediately after VHP decontamination and both 24 hours and 1 week after VHP decontamination. Nosocomial acquisition of the pathogen in the LTACH ceased after VHP Intervention. When patients colonized with MDR A. baumannii reoccupied rooms, environmental contamination recurred.

Conclusion.

Environmental decontamination using VHP combined with comprehensive infection control measures interrupted nosocomial transmission of MDR A. baumannii in an LTACH. The application of this novel approach to halt the transmission of MDR A. baumannii warrants further investigation.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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