Abstract
BackgroundOn January 7, 2019, we observed an outbreak of healthcare-associated infection (HAI) caused by Carbapenem-resistant Acinetobacter baumannii (CRAB) in the neurosurgical intensive care unit (NSICU). A follow-up epidemiological investigation was conducted, and an emergency response was initiated. We aimed to study the clonal transmission of CRAB and its possible source.MethodsA matched case-control (1:2) study was performed to identify the possible predisposing factors. A multifaceted intervention was implemented to control the outbreak. We collected environmental samples from patients’ rooms and living area of the staff. CRAB isolates were tested for genetic relatedness by Pulsed-Field Gel Electrophoresis (PFGE).ResultsEnvironmental sampling showed that a faucet aerator was contaminated with A. baumannii. Molecular typing revealed the only outbreak strain, which was isolated from tracheal aspirate cultures of the first case of community-acquired infection and 3 cases of HAI. In environmental samples, the outbreak strain was found only in the faucet aerator of the dining room. This CRAB outbreak was discovered in time, and further progress of this outbreak was prevented through a pre-set emergency response procedure.ConclusionsThe faucet aerator acted as a reservoir for bacteria in the outbreak, and contamination of the faucet aerator might have occurred from splashes originating from handwashing by the healthcare workers (HCWs). In high-risk areas, such as NSICU, the faucet aerators should not be used during an outbreak or they should be regularly cleaned and disinfected. The start-up criteria for the emergency response played a key role in controlling the CRAB outbreak, and its settings should be discussed more widely.
Highlights
Carbapenem-resistant Acinetobacter baumannii (CRAB) is emerging as a problematic pathogen for patients, clinicians, and infection-control personnel, owing to high mortality, less treatment options, and its ability to contaminate and persist in the healthcare environment at high levels [1]
In the first ever list of the deadliest superbugs that threaten human health published by the World Health Organization (WHO) in 2017, CRAB was listed in the “critical” section [2]
Outbreak investigation and response On January 7, 2019, the Infection Control Department was notified that the tracheal aspirate culture results of 5 patients in the neurosurgical intensive care unit (NSICU) showed CRAB positivity
Summary
Carbapenem-resistant Acinetobacter baumannii (CRAB) is emerging as a problematic pathogen for patients, clinicians, and infection-control personnel, owing to high mortality, less treatment options, and its ability to contaminate and persist in the healthcare environment at high levels [1]. A multi-center study in China showed that the incidence density of all CRAB isolates was 2.47 per 1000 inpatient-days in the intensive care unit (ICU), which was significantly higher than that previously reported in other regions [4, 5]. The prevalence of CRAB in China is at high levels, and CRAB has been increasingly reported as a cause of nosocomial outbreaks in ICUs [6]. On January 7, 2019, we observed an outbreak of healthcare-associated infection (HAI) caused by Carbapenem-resistant Acinetobacter baumannii (CRAB) in the neurosurgical intensive care unit (NSICU). We aimed to study the clonal transmission of CRAB and its possible source
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