Mr Yu Lyu1
1Sichuan Academy Of Medical Sciences And Sichuan People’s Hospital, Chengdu, China
On January 7, 2019, we noticed 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 the emergency response was started. We aimed to study the clonal transmission of CRAB and its possible source.
A matched case–control (1:2) study was performed to identify possible predisposing factors. A multifaceted intervention was implemented to control the outbreak. We collected environmental samples from patients’ rooms and staffs living area. CRAB isolates were studied for genetic relatedness by Pulsed-Field Gel Electrophoresis (PFGE).
Environmental sampling showed the faucet aerator to be contaminated with A. baumannii. Molecular typing revealed the only outbreak strain, which isolated from tracheal aspirate cultures of the first community infection case and 3 HAI cases. In environmental samples, the outbreak strain was only found in the faucet aerator of dining room. This CRAB outbreak was discovered in time and prevented from further progress through a pre-set emergency response procedure.
The faucet aerator acted as a reservoir for bacteria in the outbreak, and the pollution of the faucet aerator might come from splashes originating from healthcare workers (HCWs) washing their hands. In high-risk areas such as NSICU the faucet aerators should not be used or be regularly cleaned and disinfected. The start-up criteria for emergency response played a key role in controlling CRAB outbreak and its settings should be discussed more widely as other infection control measures.
Secretary of Sichuan Provincial Healthcare-associated Infection Quality Control Center
Attending physician of Healthcare-associated Infection Control Center of Sichuan Provincial People’s Hospital