A multilayered infection control intervention on carbapenem-resistant Acinetobacter baumannii acquisition: An interrupted time series

IF 3.8 3区医学 Q2 INFECTIOUS DISEASES

American journal of infection control Pub Date : 2025-01-01 DOI:10.1016/j.ajic.2024.08.018

Daniel Grupel MD , Abraham Borer MD , Riki Yosipovich RN , Ronit Nativ RN, MPH , Orli Sagi PhD , Lisa Saidel-Odes MD

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引用次数: 0

Abstract

Background

Carbapenem-resistant Acinetobacter baumannii (CRAB) causes life-threating hospital-acquired. Due to a limited number of Intensive-Care-Unit (ICU) beds, these patients are often treated in high-dependency (HD) non-ICUs within internal-medicine wards (IMW) in Israel. We aimed to assess the effectiveness of a multilayered infection-control intervention on CRAB infection rate in IMWs, especially in its HD non-ICUs with ongoing CRAB transmission.

Methods

A quasi-experimental, before-and-after, interrupted time-series study with control outcomes. We conducted a multilayered intervention over 3.5 years, which included 4 phases: (1) Pre intervention; (2) Intervention introduction: introduced enhanced environment cleaning; (3) Intervention phase 1: introduced active surveillance; (4) Intervention phase 2: introduced CRAB-positive patient cohorting, in addition to previous ongoing measures taken.

Results

CRAB was isolated from 204 patients aged 69.8y/o ± 15.86y, 59.8% male, 34.3% had CRAB-positive clinical samples. Mean hospital length-of-stay was 30.5 days, with a 30-day postdischarge mortality rate of 55.9%. Mean CRAB clinical cases decreased from 0.89 in preintervention to 0.11 at the end of phase 2, with a change in slope and level after the intervention of P = .02 (CI: − 0.204 to − 0.040) and P = .004 (CI: − 0.013 to − 0.003), respectively.

Conclusions

This intervention, including enhanced environment cleaning, active surveillance, and patient cohorting, successfully reduced CRAB acquisition in IMWs and their HD non-ICUs.

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针对耐碳青霉烯类鲍曼不动杆菌感染的多层次感染控制干预：间断时间序列。

背景：耐碳青霉烯类鲍曼不动杆菌（CRAB）会导致危重病人在医院获得性感染，危及生命。由于重症监护病房（ICU）床位有限，这些患者通常在以色列内科病房（IMW）的高依赖性（HD）非重症监护病房接受治疗。我们的目的是评估多层次感染控制干预措施对内科病房（尤其是存在 CRAB 传播的 HD 非重症监护病房）CRAB 感染率的影响：从 2019 年 1 月到 2022 年 6 月，我们开展了一项带有对照结果的前后间断时间序列准实验研究。我们在 3.5 年的时间里进行了多层次干预，包括 4 个阶段：1) 干预前；2) 干预引入：引入强化环境清洁；3) 干预阶段 1：引入主动监测；4) 干预阶段 2：除先前采取的持续措施外，引入 CRAB 阳性患者队列：从 204 名患者中分离出 CRAB，年龄为 69.8 岁/o ± 15.86 岁，59.8% 为男性。其中 34.3% 的患者临床样本呈 CRAB 阳性。平均住院时间为 30.5 天，出院后 30 天的死亡率为 55.9%。CRAB临床病例平均值从干预前的0.89降至第二阶段结束时的0.11，干预后的斜率和水平变化分别为p= 0.02（CI：-0.204-至-0.040）和p=0.004（CI：-0.013-至-0.003）：这种多层次的干预措施，包括加强环境清洁、主动监测和患者分组，成功地减少了IMW及其HD非ICU中CRAB的获得。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of infection control 医学-传染病学

CiteScore

7.40

自引率

4.10%

发文量

479

审稿时长

24 days

期刊介绍： AJIC covers key topics and issues in infection control and epidemiology. Infection control professionals, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC)