Strategy to limit multidrug-resistant Acinetobacter baumannii transmission in a cohort coronavirus disease 2019 (COVID-19) critical care unit

• Published in: Infection control and hospital epidemiology Vol. 43; no. 10; pp. 1517 - 1518
• Main Authors: Apisarnthanarak, Anucha, Weber, David J.
• Format: Journal Article
• Language: English
• Published: New York, USA Cambridge University Press 01.10.2022
• Subjects: Acinetobacter baumannii; Acinetobacter Infections - drug therapy; Acinetobacter Infections - epidemiology; Ammonium; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotics; Coronaviruses; COVID-19; Critical Care; Cross Infection; Disease transmission; Disinfection; Drug Resistance, Multiple, Bacterial; Epidemics; Humans; Hydrogen peroxide; Intensive Care Units; Letter to the Editor; Patients; Personal protective equipment; Prevention; Protective equipment; Staphylococcus infections; Thailand
• ISSN: 0899-823X; 1559-6834; 1559-6834
• DOI: 10.1017/ice.2021.289

To the Editor—Coinfection with multidrug-resistant organisms (MDROs) among coronavirus disease 2019 (COVID-19) patients is common in critical care patients with a prolonged length of stay in critical care units, likely due to the coadministration of high-dose steroids and the prolonged duration of mechanical ventilation.1 The control of MDROs among COVID-19 patients is also difficult, given the requirement for airborne plus contact isolation among these patients and the difficulty in wearing and changing personal protective equipment (PPE) in a critical care unit.2 The situation is much more challenging in middle- and lower-income countries where cohort areas in airborne-isolation critical care units are often designed, instead of single airborne-isolation rooms in the critical care unit. A policy to prevent transmission was initiated that included isolation of MDR A. baumannii patients in single-bed isolation rooms, assigning specific nurses to care for cases with MDR A. baumannii, changing gloves between cases, putting an extra sheet cover on the provider between care for MDR A. baumannii cases and daily environmental disinfection in cohort and single beds with a quaternary ammonium compound. Additional interventions at this stage included unit closure for hydrogen peroxide vapor disinfection, development of risk stratification criteria for housing high-risk patients with MDR A. baumannii in the 2 isolation rooms, development of an antibiotic stewardship program to limit broad-spectrum antibiotics and to de-escalate broad-spectrum antibiotics among COVID-19 patients, and development of a policy to discontinue isolation for COVID-19 patients.3 Continuous monitoring and feedback of MDR A. baumannii incidence and infection prevention compliance with such policies among HCP was performed daily.