Maximum Isolation Precautions for Prevention and Control of Multi-Drug Resistant Acinetobacter baumanni (MDR-Ab)

ISSUE: MDR-Ab is a gram-negative bacilli which has been reported worldwide and is recognized as a difficult health-care associated infection to control and treat. In January 2004 we created a new catagory of isolation Precautions to contatin an MDR-Ab outbreak and prevent the organism from becoming endemic in the institution. PROJECT: Beginning in January 2004 we created a new category of Maximum Isolation Precautions to prevent transmission of MDR-Ab based on the control measures reported to us by three large acute care facilities.We define MDR-Ab as isolates susceptible to no more than one class of antimicrobial agents,excluding colistin. To assure we capture cases, the Microbiology Laboratory notifies us of cultures growing MDR-Ab and we survey the microbiology database for isolates of MDR-Ab. For patients colonized or infected with MDR-Ab Maximum Isolation Precautions require a private room and one to one nursing. Gown and gloves are required upon entering the room and a mask is required if MDR-Ab is in the sputum. Nurses caring for patients with MDR-Ab do not concurrently care for any non-MDR-Ab patients. Each patient with MDR-Ab has dedicated equipment. Respiratory, Physical, and Occupational therapists care for only patients with MDR-Ab or see these patients at the end of the day. All providers are asked to limit the number of individuals entering the isolation room. Designated staff performs thorough environmental cleaning. We developed educational materials for staff and patients. Patients colonized or infected with MDR-Ab are flagged with an isolation code in the hospital database. RESULTS: Between January 2003 and October 2005, 52 patients grew MDR-Ab at JHH, 33 (63.5%) of the patients grew the organism more than 48 hours after admission. The incidence of MDR-Ab growing in a clinical culture more than 48 hours after admission was 3.78 per 100,000 patient-days in 2003, 5.20 per 100,000 patient-days in 2004, and 4.27 per 100,000 patient-days in 2005. LESSONS LEARNED: The incidence of MDR-Ab at JHH has been stable over the past 3 years and the number of patients remains relatively low. We feel that our early implementation of Maximum Isolation Precautions is responsible for our successful control of MDR-Ab. Challenges include staffing issues, bed allocation, and added expense. Investigation is needed into alternative, less burdensome infection control strategies for this organism.