Implementation of a multimodal infection control program during an Acinetobacter outbreak

Summary 

Objectives

Acinetobacter in the ICU presents a challenge worldwide due to its capacity for long-term survival on environmental surfaces. This report describes a multimodal infection control program designed to control a sustained outbreak Acinetobacter colonization.

Methods

Multimodal interventions implemented by unit-appointed infection control nurses in an Australian intensive care unit (ICU) during a sustained outbreak of Acinetobacter colonization.

Results

In the first 12 months of the outbreak, the mean monthly colonization rate was 3.1 (±1.2) cases per 100 bed-days (increased from 0.5 [±0.4] in the previous 6 months). In the subsequent 20-months, the mean monthly colonization rates declined to 1.5 (±1.5) cases per 100 bed-days (P=0.004). Hand hygiene compliance increased from 33% (95% CI 30–36%) before action plan implementation to 49% (95% CI 46–52%) measured 6-months after implementation. Compliance subsequently dropped to 39% (95% CI 36–42%) 12-months after implementation. The median volume of alcohol/chlorhexidine hand rub solution used per 1000 bed-days increased from 24L (interquartile range (IQR) 12–47L) to 148L (IQR 120–165L) per 1000 bed-days (P<0.001).

Conclusions

Introduction of ICU-appointed infection control nurses, who then led multimodal interventions, was effective in reducing the rate of Acinetobacter colonization.

Keywords: Acinetobacter, Infection control, Nosocomial infection, Hand hygiene, Alcohol-based hand rub, Intensive care unit