Dallas hospital stops MDRO outbreak in its tracks
Quick reaction allowed one facility to keep an outbreak of Acinetobacter at bay
After reading this article, you will be able to:
- Summarize the prevention efforts by Methodist Dallas Medical Center to prevent an Acinetobacter outbreak
- Recognize the importance of contact precautions during an outbreak
- Describe how the hospital’s administration supported the IC team
In February, a study—conducted by Extending the Cure, a research project under Resources for the Future that studies the growing problem of antibiotic resistance—was published in Infection Control and Hospital Epidemiology indicating that drug-resistant strains of Acinetobacter have increased more than 300% from 1999 to 2006 (see the March Briefings on Infection Control).
But this was old news to staff members at Methodist Dallas Medical Center, since they experienced the effects of an outbreak firsthand. In 2009, the facility identified four cases of Acinetobacter in a one-week period in the hospital’s critical care unit (CCU).
Beth Wallace, MPH, CIC, IP at Methodist Dallas Medical Center, shared her experiences of the incident at APIC’s 37th Annual Conference and International Meeting, July 11–15.
IC and frontline staff members were able to quickly stop the outbreak from circulating through the hospital and prevent further infections through quick, effective interventions such as contact precautions and active surveillance.
“With outbreaks of pan-resistant Acinetobacter baumannii and other multi-drug resistant organisms on the rise, it is absolutely essential that infection prevention departments be fully staffed and adequately resourced,” APIC president Cathryn Murphy, RN, PhD, CIC, said in a press release. “Methodist Dallas Medical Center was proactive in their approach, responding rapidly and mobilizing an interdisciplinary team to control the outbreak. The experiences of infection preventionists such as Ms. Wallace serve as practical guidance for healthcare professionals combating multi-drug resistant pathogens. Their experience is a powerful reminder that aggressive infection prevention programs are required to protect patients and save lives.”
The first signs
The IC team at Methodist Dallas Medical Center noticed signs of the organism through routine surveillance. It was relatively easy to spot since healthcare facilities can go several weeks or even months without ever seeing a case of Acinetobacter.
In this case, the infection prevention team noticed four cases in a seven- to 10-day span, which caught their attention and prompted an investigation.
“The first thing that we did is we noticed that three of those four cases were all in one of our critical care units, and so we put every patient in that unit into contact precautions, requiring gloves and gowns upon entry into the room,” Wallace says. “And we also did surveillance cultures of every patient who was in that unit just to try and have an idea of whether or not there were other patients we didn’t know of.”
During their first round of surveillance, staff members discovered a case in their surgical ICU (SICU), so they extended the same interventions—contact precautions and twice-a-week surveillance—to the SICU as well.
Being prepared for a potential outbreak helped the process run more smoothly, Wallace says, as well as having knowledge of current best practices.
“We do have an outbreak investigation policy that helps guide us through this kind of thing, but we are definitely also always trying to keep tabs on the latest literature,” she says.
Implementing contact precautions
The first and most important prevention measure the hospital took was to implement contact precautions across the CCU when the outbreak was first discovered.
Contact precautions are always a significant burden to staff members, especially when it’s not just one or two patients, but an entire 15-bed unit. However, staff members were concerned about the outbreak and wanted to be sure they didn’t spread the organism to themselves or any other part of the hospital.
This led to self-policing, usually considered the best method for achieving compliance.
“We generally do isolation compliance rounds fairly regularly,” Wallace says. “Throughout the course of this we were in the unit often, but I think there was also a lot of holding one another accountable because there was no way we could be there 24/7.”
The heightened measures lasted for roughly seven weeks before the outbreak dissipated, which was a favorable time frame for this particular bacteria. “It’s long, but if you look in the literature, Acinetobacter outbreaks can actually last up to years, so this was actually very quick.”
Getting administrative support
As the published research in February indicated, Acinetobacter is becoming a legitimate concern for facilities already dealing with prevention of multidrug resistant organisms such as MRSA and C. diff, which have been historically more prevalent in healthcare.
“I think that it’s going to be an increasing problem throughout the country, and looking at the literature, outbreaks of Acinetobactor are occurring more and more often throughout the world,” Wallace says. “Often what you see in the United States is that military folks bring it back with them from Iraq. That is not the population that we have seen it in, but that is a source of concern as well.”
But that concern can’t come from the IC staff alone. Wallace insists that what made their prevention efforts a success was support from administration in ensuring that the IC department was fully staffed and had the appropriate resources.
This also created an environment in which everyone in the hospital was involved with prevention efforts when the outbreak occurred, not just the IC team or frontline staff members.
“I think the most important thing that we did is we had really all the players at the table from the beginning,” Wallace says. “We involved everyone from administration, nursing, physicians, the lab, including physical plants, and environmental services. We really had everyone involved so we could hit this from every angle.”