NEW YORK (Reuters Health) - A nosocomial outbreak of multidrug-resistant Acinetobacter baumannii (MCR-Ab) has been traced back to a device that uses high-pressure irrigation to debride wounds, investigators report in the December 22/29 issue of the Journal of the American Medical Association.
In October 2003, Dr. Lisa L. Maragakis and colleagues at Johns Hopkins Hospital in Baltimore identified a cluster of five patients harboring MCR-Ab, which was approximately five times the usual rate. Isolates were susceptible to only one drug, colistin.
Further investigation identified a total of 11 case patients harboring MCR-Ab between September 1st and October 31st. Ten of these patients acquired the infection in the hospital. Eight had received pulsatile lavage treatment.
Three patients required treatment in the intensive care unit for sepsis and respiratory distress, and two deaths were possibly related to the infection.
The outbreak strain was cultured from the disposable pulsatile lavage gun and suction canister insert, as well as surfaces in the treatment area.
There had been a change to save costs in the pulsatile lavage procedure approximately 2 months prior to the outbreak: Suction canister inserts, which were previously changed after each patient, were changed once a day or when full.
On October 24th, the wound care treatment room was temporarily closed to allow through cleaning and disinfection. New private rooms that were constructed were to be used for pulsatile lavage only.
After these measures were taken, no further cases of the outbreak strain were detected. Environmental cultures of surfaces in the treatment rooms tested negative for MCR-Ab over the next 11 months.
Health care workers performing pulsatile lavage should use personal protective equipment, Dr. Maragakis and her associates advise. “In addition, patients receiving pulsatile lavage treatment should wear surgical masks and all intravenous lines and other wounds must be covered during the treatment.
“This outbreak highlights the importance of careful evaluation of the infection control implications of new therapies, existing therapies used in a new way, and cost-saving procedural changes,” the authors conclude.
Source: JAMA 2004;292:3006-3011. [ Google search on this article ]
MeSH Headings:Biological Phenomena: Biological Phenomena, Cell Phenomena, and Immunity: Biological Sciences: Biology: Disease Outbreaks: Drug Resistance, Microbial: Environment and Public Health: Genetics: Genetics, Microbial: Health: Health Occupations: Hemodynamics: Disorders of Environmental Origin: Medicine: Microbiologic Phenomena: Investigative Techniques: Pharmacogenetics: Physical Sciences: Physics: Population Characteristics: Preventive Medicine: Public Health: Pulsatile Flow: Rheology: Specialties, Medical: Wounds and Injuries: Analytical, Diagnostic and Therapeutic Techniques and Equipment: Biological Sciences: Diseases: Health Care: Physical SciencesCopyright © 2002 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
