A Novel Comprehensive Infection Control Protocol; Prevention and Eradication of Multiresistant Organisms Outbreak in the Intensive Care Unit Using a Multidisciplinary Approach

SESSION TITLE: Chest Infections Posters I SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: Clostridium difficile (C. difficile) and Multidrug Resistant Organisms (MDROs) continue to pose a major problem in the care of intensive care unit (ICU) patients. They can increase length of stay, cost of care and mortality of critically ill patients. Prompted by an outbreak of Burkholderia cepacia (B. cepacia) in our ICU, we implemented a comprehensive infection control protocol to meet the challenges of stemming this outbreak and reducing C. difficile and MDRO infection rate. METHODS: In early 2014, six percent of patients in an academic medical center ICU were identified as colonized or infected with B. cepacia, prompting an outbreak investigation. The unit was closed for terminal cleaning using hypochlorite solutions and ultraviolet germicidal irradiation. A multidisciplinary team of intensivists, nursing, environmental services and infection control specialists implemented new strategies to address unit infections. An integrated protocol was begun that included active respiratory and rectal surveillance for carbapenem-resistant Gram-negative organisms on admission and weekly, patient cohorting, terminal cleaning of rooms after all patient discharges irrespective of length of stay or colonization/infection status, daily high touch surface cleaning with 10% bleach and post-cleaning adenosine triphosphate (ATP) testing to audit environmental cleanliness. Patients with an ICU stay over 14 days, regardless of infection status, were moved to a clean room to allow terminal cleaning to decrease bioburden. We compared C. difficile and MDRO rates for the five months preceding and seven months after the implementation of the protocol. The rates were compared using normal-theory (z) test for comparing incidence rates. RESULTS: The incidence of MDRO infections in the ICU decreased by 65% from 9.1 to 3.3 per 1,000 patient-days (p=0.03) following implementation of the protocol. The incidence of B. cepacia declined to zero and remained undetectable thereafter. C. difficile rates (per 10,000 patient-days) decreased to 7.3 from 21.4 pre intervention CONCLUSIONS: The environmental bundle resulted in a significant reduction in all MDROs. A dedicated multidisciplinary team with strong leadership was required for reaching and maintaining low MDRO infection rates.. CLINICAL IMPLICATIONS: A significant decrease in MDRO rate is possible with commitment at the organization and ICU level and implementation of appropriate interventions. Control of these infection rates will help prevent high healthcare costs, morbidity, and mortality. DISCLOSURE: The following authors have nothing to disclose: Nagendra Madisi, Rohit Gupta, Anthony Manasia, Gopi Patel, Frances Wallach, John Oropello, Adel Bassily Marcus, Roopa Kohli-Seth No Product/Research Disclosure Information