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Weekly Emails to Hospital C-Suite Halt ‘Superbug’ Outbreak

A. baumannii was present for nearly two decades

Efforts to reduce and stop the spread of infections caused by a highly resistant organism, carbapenem-resistant Acinetobacter baumannii, at a large Florida hospital proved ineffective until they added another weapon — weekly emails from the medical director of Infection Control to hospital leadership, according to a new study published in the May issue of the American Journal of Infection Control.

When the hospital added the step of sending comprehensive weekly reports to physician, hospital nursing, medical, and administrative leadership, the rate of A. baumannii transmission decreased by 63%, according to researchers at the University of Miami Miller School of Medicine. Before this, endemic rates of A. baumannii had been present at the institution for nearly two decades.

“These regular, highly visible communications allowed us to create a sense of accountability for new cases that unified both the leadership and providers toward the common goal of decreasing new acquisitions of carbapenem-resistant A. baumannii,” the authors said.

The study analyzed 42 months of hospital data (from January 1, 2010 to June 30, 2013) representing 1.1 million patient-days. During phase 1 (2010–2011), a bundle of interventions had been implemented, but infection rates had not changed.

During phase 2 (2011–2012), the medical director of Infection Control sent weekly emails to hospital leadership describing and interpreting surveillance results from the previous week, including the number and location of newly discovered isolates; the results of environmental cultures obtained from bed rails, bedside tables, intravenous pumps, and nursing stations; and a map indicating the location of carbapenem-resistant A. baumannii-positive patients and bjects. Two intensive care units (ICUs) with the highest rates received daily emails.

During phase 3 (2012–2013), the bundle of interventions continued, but the weekly emails ceased because there were only scattered weekly acquisitions. The overall acquisition of new cases of carbapenem-resistant A. baumannii dropped from 5.13 per 10,000 patient-days in period 1 to 1.93 per 10,000 patient-days in period 3.

The bundle of infection prevention measures included:

  • Patient screening tests upon admission to the ICU and weekly thereafter
  • Isolation and separation of patients testing positive for A. baumannii
  • Weekly sampling of surfaces in the hospital environment to assess the thoroughness of cleaning
  • Hand hygiene interventions, including random cultures of health care workers’ hands, the results of which were included in the weekly reports
  • Observing shared objects that moved from patient-to-patient
  • Monthly multidisciplinary meetings to discuss issues related to implementing the bundle

The authors concluded: “This is the first study to examine the effect of mass electronic dissemination of results from a bundle of interventions. Weekly electronic communications were associated with a striking decrease in the rate of new acquisitions of A. baumannii at our institution, probably because of a combination of education, communication, feedback, and peer pressure.”

A. baumannii is a gram-negative bacterium that is resistant to most antibiotics. It has become one of the most worrisome and frequent organisms causing health care-associated infections in U.S. health care facilities.

Infections from A. baumannii occur mainly in ICUs and affect primarily very ill, wounded, or immunocompromised patients. The bacterium can remain on wet or dry surfaces for longer than most other organisms, making it harder to eradicate. Multidrug-resistant A. baumannii is classified as a serious threat by the Centers for Disease Control and Prevention.

Source: Medical Xpress; April 28, 2014.

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