Abstract
ObjectiveTo continuously evaluate the effect of environmental cleaning and hand hygiene compliance on the colonization and infection rates of multidrug-resistant Acinetobacter baumannii (MDR-AB) in the patients within an intensive care unit (ICU).MethodsEnvironmental cleaning on the high-touch clinical surfaces (HTCS) within a comprehensive ICU was evaluated through monitoring fluorescent marks when the overall compliance with hand hygiene during 2013–2014 was monitored. Meanwhile, samples from the HTCS and inpatients were collected and sent for bacterial culture and identification. The drug susceptibility testing was further implemented to monitor the prevalence of MDR-AB. The genetic relatedness of MDR-AB collected either from the HTCS or inpatients was analyzed by pulsed field gel electrophoresis (PFGE) when an outbreak was doubted.ResultsThe overall compliance with hand hygiene remained relatively stable during 2013–2014. Under this circumstance, the clearance rate of fluorescence marks on the environmental surfaces within ICUs significantly increased from 21.9 to 85.7%, and accordingly the colonization and infection rates of MDR-AB decreased from 16.5 to 6.6‰ and from 7.4 to 2.8‰, respectively, from the beginning to the end of 2013. However, during 2014, because of frequent change and movement of environmental services staff, the clearance rate of fluorescence marks decreased below 50.0%, and the overall colonization and infection rates of MDR-AB correspondingly increased from 9.1 to 11.1‰ and from 1.5 to 3.9‰, respectively. PFGE displayed a high genetic relatedness between the MDR-AB strains analyzed, indicating a dissemination of MDR-AB during the surveillance period.ConclusionFor the easily disseminated MDR-AB within ICUs, the clearance rate of fluorescence labeling on HTCS is negatively correlated with the hospital infection rate of MDR-AB. Such an invisible fluorescence labelling is an effective and convenient method to continuously monitor cleanness of medical environment within hospitals.
Highlights
Healthcare-associated infection (HAI) is a global problem for patients, especially those inpatient with immunocompromised or critically ill diseases, causing extended hospital stays, high costs, and high mortality [1]
For the disseminated multidrug-resistant Acinetobacter baumannii (MDR-AB) within intensive care unit (ICU), the clearance rate of fluorescence labeling on high-touch clinical surfaces (HTCS) is negatively correlated with the hospital infection rate of MDR-AB
Epidemiological studies showed that HAI is closely associated with microbial pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA) [2, 3], vancomycin-resistant Enterococci (VRE) [3], and multidrug-resistant Gram-negative bacilli [4], which could be spread by the hospital environment surfaces [5]
Summary
Healthcare-associated infection (HAI) is a global problem for patients, especially those inpatient with immunocompromised or critically ill diseases, causing extended hospital stays, high costs, and high mortality [1]. In China, the prevalence of multidrug-resistant Acinetobacter baumannii (MDRAB) greatly exceeds both MRSA and VRE [8, 9], and the frequent expansion of MDR-AB poses tough challenges to control HAIs, especially those occurred in ICUs [10, 11]. A. baumannii possesses the super survivability on kinds of healthcare equipment surfaces, from 5 days to more than 5 months [12], which surely increases the chance of transmission of MDR-AB. Such strain is difficult for prevention once it acquires resistance to the conventional detergents and alcohol disinfectants [13]. The targeted infection control measures of MDR-AB, including hand hygiene, environmental cleaning and subsequent measurement of cleanliness, are imperative to eradicate the nosocomial acquisition and further dissemination
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