05/16/2013 // Concord, CA, USA // LifeCare123 // Greg Vigna, MD, JD // (press release)
(LifeCare123.com News) As a clinician with over twenty years of experience providing care for patients with a variety of chronic medical conditions such as traumatic brain injury, spinal cord injuries, burn patients, and patients with decubitus ulcers in rehabilitation facilities, I began seeing MDR Acinetobacter patients coming into my facility with increasing frequency. I extensively researched this bacteria regarding how to treat these unfortunate patients and investigated the best practice techniques to prevent the spread of this organism to other patients in the facility. Surprisingly I came across the following headline during my Google search:
“Detectives from Tokyo’s metropolitan Police Department are conducting a manslaughter investigation of Tokyo University Hospital officials who failed to alert authorities or patients to a prolonged outbreak of MDR-Acinetobacter more than 50 Tokyo hospital patients were infected and medical officials believe at least nine patients may have died directly as a result of Acinetobacter infections.”(epiNewswire)
Early investigation and research during my clinical practice provided little help from the Centers of Disease Control and other government agencies. Basically, clinicians across the country were on their own to develop infection control practices for their individual health care facilities. More recently, the Centers of Disease Control have published recommendations for hospitals and other medical facilities related to this problem.
The most important feature regarding Acinetobacter is the propensity to cause outbreaks in a health care setting. There is no specific line that can be drawn in what would be considered to be an outbreak. Johns Hopkins Medical Center set a standard, which I consider the best management practice of this problem. With the commitment of hospital administration, infection control best practices were implemented at my health care facility. It should be recognized that the presence of one patient with a MDR Acinetobacter should mobilize a facility’s infection control measures. Health care institutes must have a vigilant infection control mechanism, ongoing surveillance, and policy and procedure protocols to deal with this organism.
An Acinetobacter outbreak will increase the length of stay, cause prolonged ICU stays, and would certainly have a far reaching public relations impact if an outbreak were to occur and not be contained. Health care outbreaks have occurred in a variety of settings with a majority in adult ICU units but have been found in neonatal intensive care units, burn units, oncology units, internal medicine units, surgical units, and neurosurgical care units. Health care institutes must be aware of any patient with a MDR Acinetobacter. Risk factors for such an infection include decubitus ulcers, prematurity, previous antimicrobial therapy, patients who have received blood, contaminated IV solutions, feeding tubes, and patients with extended length of stays and admissions due to high density infected or colonized patients. As a rehabilitation physician caring for patients with spinal cord injuries, brain injuries, burn patients, and those on ventilators, this is a particularly dangerous organism with a disproportionate impact on my patients because of the extended inpatient rehabilitation stay that is required after initial injury and recurrent hospitalizations that are often required over their lifetimes. In the hospital setting transmission can occur by a variety of mechanisms including direct contact with contaminated hands of healthcare workers, by contact with a colonized or infected patient, indirect contact by touching an object with the organism, or airborne transmission.
In an outbreak in an ICU in Holland involving sixty-six patients with an epidemic strain, 15 nursing staff members were cultured positive with the same strain. Various objects had tested positive during the outbreak including bedrails, ventilators, sinks, shower trolleys, pillows, mattress, steel trolleys, suctioning equipment, and wash basins. Basically, any object may be a source of contamination in a hospital setting.
It is unclear to what frequency outbreaks are occurring in acute hospitals, acute rehabilitation hospitals, long-term acute care hospitals, and skilled nursing facilities. There has been inadequate leadership from federal government agencies, the Joint Commission, and state government agencies regarding the requirement for implementation of best practice protocols as a condition for payment to protect patients from infection. Any future mandate must be accompanied by increased funding to provide for isolation rooms, education, increased length of stays, and increased administrative cost necessary to achieve these mandates. Only then can patients be provided a safe environment.
To read Part 1 of this article, please see Multi-Drug Resistant Acinetobacter- A Threat To All
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