Louisiana team approach prevents harmful infection from spreading among vulnerable patients
A state health department's quick action to mobilize an inter-facility response to protect ventilator-dependent residents of a skilled nursing facility from a superbug outbreak in the middle of the pandemic is being highlighted at an infection control conference today.
In a poster presented at the Association for Professionals in Infection Control and Epidemiology's (APIC) 49thAnnual Conference, June 13-15 in Indianapolis, the Louisiana Department of Health detailed the response, which started when an acute care hospital noted three patients with carbapenem-resistant Acinetobacter baumannii originating from the same ventilator skilled nursing facility in August 2020.
"Credit first goes to the hospital whose surveillance picked up this cluster of infections," said Erica Washington, MPH, CPH, CIC, CPHQ, FAPIC, the healthcare-associated infection and antibiotic resistance program coordinator for the Louisiana Department of Health and poster presenter. "Had their infection preventionist not contacted us, this antibiotic-resistant organism could have infected many more patients."
Listed as an 'urgent threat' in the CDC's antibiotic resistance threat report, carbapenem-resistant A. baumannii can cause urinary, bloodstream, lung, and wound infections. It is resistant to carbapenem—an antibiotic of last resort. Patients who are hospitalized or on ventilators are at higher risk of becoming infected.
Within days of being notified of the cases, the Louisiana Department of Health launched an in-person, infection control assessment and response (ICAR) survey at the nursing facility and issued infection control recommendations based on their observations. Recommendations centered on improved hand hygiene, including removal of healthcare workers' gel nail polish (which harbor germs), and enhanced environmental cleaning protocols.
In addition, nursing home residents underwent colonization screening to track any spread of the organism. Following implementation of infection control recommendations and two rounds of colonization screening, no additional cases of A. baumannii were detected.
"Ventilated patients require a lot of hands-on care, so hand hygiene is critical to any infection prevention effort, but especially so when dealing with a multidrug-resistant organism," explained Washington. "And because Acinetobacter baumannii is so hardy in the environment, we had to make sure the facility was using the correct cleaning agents and also spot checking to ensure proper cleaning was being done."
Washington also credits the coordinated efforts of state and federal public health partners, working in collaboration with the skilled nursing facility, the acute care hospital, and the CDC's antibiotic-resistance laboratory network, which provided free colonization testing to all nursing home residents on the ventilator unit where the previous cases were detected.
"I think our success really speaks to the power of collaboration between local healthcare providers and public health," said Washington. "When we work together, we can detect and contain antibiotic-resistant threats and stop potentially deadly disease outbreaks."
"As patients move between facilities, their germs go with them," said 2022 APIC President, Linda Dickey, RN, MPH, CIC, FAPIC. "Collaboration throughout the healthcare community is essential when confronted with drug-resistant organisms."