Containing an A baumannii Infection Outbreak Across Multiple Facilities

The highly contagious pathogen Acinetobacter baumannii requires aggressive containment under current guidance. The infection occurs almost exclusively in health care settings and patients with weak immune systems or very ill hospital patients are at an increased risk.

Research presented at the Association for Professionals in Infection Control and Epidemiology (APIC 2019) Annual Conference analyzed the 6-month containment of a multi-facility outbreak of A baumannii infection. On January 1, 2018, the state public health laboratory alerted the state health department to a case of Pan-nonsusceptible A baumannii infection in a hospital. The patient, referred to as Patient A, was brought to the hospital from a skilled nursing facility with the capacity to treat ventilated patients (vSNF). Prior to the vSNF, the patient had been receiving care in a long-term acute care hospital.

While at the hospital, Patient A shared a bathroom with Patient B, who also developed the infection. In response to the cases of A baumannii, the state health department and the US Centers for Disease Control and Prevention (CDC) worked together over 6 months to identify and contain the transmission.

As part of the investigation, state health officials conducted in-person evaluations of infection control and addressed gaps with both phone calls and written feedback. The long-term care facility and vSNF underwent point prevalence surveys every 2 weeks, until there were 2 consecutive rounds of testing with no new cases.

According to the investigators, screening was performed on rectal, sputum, and wound specimens. And isolates were sent the CDC for whole genome sequencing and OXA-23 testing.

As part of the outbreak investigation, the vSNF and LTACH (long-term acute care hospital) performed 6- and 10-point prevalence surveys, respectively, between January 31 and June 27, 2018. The surveys, coupled with admission screenings, identified 12 cases, 8 of which had OXA-23-producing strains. Additionally, the pan-NS cases were found to demonstrate intermediate or resistant interpretations to all antibiotics tested and multidrug-resistant cases showed susceptibility to 1 antibiotic tested.

The investigation through whole genome sequencing found evidence that transmission occurred in the vSNF, reporting further that the facility did not have hand hygiene monitoring, nor contact precaution signage, and there were inconsistencies in the use of personal protective equipment and inadequate disinfection.

Additionally, the LTACH was found to not be engaging in adequate equipment disinfection practices.

All recommendations made to encourage sanitation and hygiene were sustained and in June 2018, transmission stopped at both facilities.

The study, “Multi-Facility Containment of a Multidrug-resistant Acinetobacter Baumunnii Outbreak — January 2018- July 2018 (OIPH-20),” was presented Thursday, June 13, at APIC 2019 in Philadelphia, Pennsylvania.