Effect of daily pillow cover replacement on the incidence of carbapenem resistant Acinetobacter baumannii (CRAB) in the medical intensive care units (MICU): a comparative study.
JinWoong Suh, KyungSook Yang, JeongYeon Kim, YoungKyung Yoon, JangWook Sohn
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引用次数: 0
Abstract
Background: Critically ill patients in intensive care units (ICUs) are at risk for colonization and infection by carbapenem-resistant Acinetobacter baumannii (CRAB), a multidrug-resistant pathogen with high mortality. Despite the use of infection control bundles, CRAB often persists on environmental surfaces, posing ongoing challenges for containment. The potential impact of managing soft environmental reservoirs-such as pillow covers-remains underexplored. This study evaluated whether daily pillow cover replacement can reduce CRAB acquisition in a medical ICU (MICU).
Methods: A prospective intervention study was conducted in a 23-bed MICU at a tertiary hospital in Korea between August 2023 and July, 2024. Standard infection prevention and control (IPC) practices, including hand hygiene, cohort isolation, chlorhexidine bathing, and routine cleaning, were consistent throughout the study. Starting February 1, 2024, pillow covers were replaced regularly as an additional intervention. CRAB acquisition was defined as positive clinical cultures obtained > 48 h after admission. Incidence rates were compared between the pre- and post-intervention periods using Poisson regression and interrupted time series analyses.
Results: A total of 152 patients met the inclusion criteria (108 pre- and 44 post-intervention). In this study, 224 CRAB-positive clinical specimens were identified from 152 patients, and only the first isolate per patient was included in the incidence analysis. The mean age was 76 years; 59.9% were male, and the average MICU stay was 26 days. Sputum accounted for 76.8% of CRAB-positive specimens. Compliance with daily pillow cover replacement was 100%. Poisson regression revealed a significant reduction in CRAB incidence following the intervention, with a 3.92% weekly decrease (95% CI 0.10-7.69%; p = 0.045).
Conclusions: When integrated into existing IPC bundles, daily pillow-cover replacement may reduce CRAB cross-transmission in the MICU. This simple, low-cost intervention with high compliance offers a promising strategy for improving environmental hygiene and infection control in high-risk settings.
背景：重症监护病房（icu）的危重患者存在碳青霉烯耐药鲍曼不动杆菌（螃蟹）定殖和感染的风险，螃蟹是一种高死亡率的多药耐药病原体。尽管使用了感染控制包，但螃蟹经常在环境表面持续存在，对遏制构成持续挑战。管理软环境水库的潜在影响——比如枕套——仍未得到充分的探索。本研究评估每日更换枕套是否可以减少医学重症监护病房（MICU）的螃蟹获得。方法：于2023年8月至2024年7月在韩国某三级医院23张床位的MICU进行前瞻性干预研究。标准感染预防和控制（IPC）措施，包括手部卫生、队列隔离、洗必泰沐浴和常规清洁，在整个研究过程中都是一致的。从2024年2月1日开始，作为额外的干预措施，枕套会定期更换。螃蟹获得定义为入院后48小时获得阳性临床培养。使用泊松回归和中断时间序列分析比较干预前后的发病率。结果：共有152例患者符合纳入标准（干预前108例，干预后44例）。在本研究中，从152例患者中鉴定出224例螃蟹阳性临床标本，仅将每位患者的第一例分离物纳入发病率分析。平均年龄76岁；男性占59.9%，平均住院时间为26天。痰液占螃蟹阳性标本的76.8%。每日更换枕套的依从性为100%。泊松回归显示，干预后螃蟹发病率显著降低，每周下降3.92% （95% CI 0.10-7.69%; p = 0.045）。结论：当纳入现有的IPC包时，每日更换枕套可能会减少MICU中CRAB的交叉传播。这种简单、低成本、高依从性的干预措施为改善高风险环境中的环境卫生和感染控制提供了一种有希望的策略。
期刊介绍：
Antimicrobial Resistance and Infection Control is a global forum for all those working on the prevention, diagnostic and treatment of health-care associated infections and antimicrobial resistance development in all health-care settings. The journal covers a broad spectrum of preeminent practices and best available data to the top interventional and translational research, and innovative developments in the field of infection control.
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