Authors (including presenting author) :
CHING H C R (1), FUNG S C K (1), NG K B (1), LEUNG M K (1), CHEUNG P S (2), CHAN H L (2)
Affiliation :
(1) Infection Control Team, UCH, HKSAR (2) Department of Medicine and Geriatrics, UCH, HKSAR
Introduction :
Multidrug-resistant Acinetobacter (MDRA) is an important nosocomial opportunistic pathogen causing infections mainly in mechanically ventilated and critically ill patients. The limited antibiotic treatment options lead to high morbidity and mortality, increase in hospital stay and cost. The trend of Acinetobacter species that demonstrate in vitro resistance to any 4 out of the 5 classes of antibiotics (Cephalosporins, Fluoroquinolones, Aminoglycosides, Beta-lactam with or without beta-lactamase inhibitor and Carbapenems) are closely monitored for prompt control measures by the Infection Control Team (ICT). Those isolates that are resistant to 4 or 5 classes of antibiotics are defined as polydrug resistant Acinetobacter (PDRA) and multidrug resistant Acinetobacter (MDRA) respectively. It was observed that rate of nosocomial MDRA rate per 1,000 patient bed days raise from 0.065 in 1Q 2022 to 0.136 in 2Q 2022 in the medical department.
Objectives :
The aim of the bundle approach is to prevent and control the nosocomial spread of MDRA in hospital setting.
Methodology :
The United Christian Hospital (UCH) is a 1,300 official bed acute regional hospital with 45 bed respiratory ward for these patients. It was observed that the increase of MDRA was from the respiratory ward. Working together with the relevant stakeholders, a six-point infection control program (“bundle”) was instituted in 2Q 2022 and consisted of the following measures: 1. Step-up of hand hygiene antiseptics using 0.5% Chlorhexidine Gluconate with 70% alcohol to replace the alcohol hand rub in cohort cubicles, ensure availability of point-of care hand-rubs for easy access. The frequency of staff education and hand hygiene compliance audit was increased. 2. Implemented contact precautions and encourage placement of patients colonized or infected with PDRA/MDRA in single room or cohort in the same cubicle, and reinforced by daily patrol by IC nurses. 3. Dedicated use of non-critical items (e.g., sphygmomanometers, stethoscopes) and the devices were kept inside the rooms. 4. Provided Chlorhexidine (CHG) bath using 4% CHG solution or CHG wipes for PDRA/ MDRA patients to reduce skin bacterial load. 5. Used 2-in-1 detergent and chlorine-based disinfectant solution containing 1000 ppm chlorine for environmental decontamination. 6. Monitored for environmental cleanliness and conducted regular culture of the environment to reinforce the importance of environmental reservoirs and cross-transmission.
Result & Outcome :
The nosocomial MDRA rate per 1,000 patient bed days was significant decreased from 0.136 at 2Q 2022 to 0.037 in 2Q 2023 and no case was reported in 3Q 2024. The effect was persistent and the rate remained constant thereafter. Conclusion: This study showed the importance of multi-faceted control program with engagement of stakeholders for implementation of infection control measures. Implementation of the “bundle” program has resulted in a long-term control of the transmission of the drug resistant acinetobacters.
