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Hospital's Fast Action Stops Potentially Disastrous HAI

Cheryl Clark, for HealthLeaders Media, July 14, 2010

The great thing about working with HealthLeaders is that I learn at least one fascinating fact about healthcare every day, a benefit I missed when I took some time off last week.

On my first day back, a "good news" paper presented at a meeting of infection control professionals got my attention with another intriguing aspect of hospital care.

It told how a fast-acting Dallas hospital put an abrupt end to a cluster of an increasingly feared drug-resistant strain of bacteria, Acinetobacter baumanni. Ab, as it is referred to, has been terrorizing a growing number of health facilities in recent years since it was discovered imbedded in the wounds of military troops returning from Iraq nearly a decade ago.

The particular strain is called Ab-XDR, which stands for "extensively drug resistant." Only two antibiotics, colistin or polymyxin B—drugs that carry high risk for kidney damage—have some reliability to fight it.

Methodist Dallas Medical Center turned itself upside down after four hospital-acquired cases of the potentially devastating organism were identified during one week, last fall. Over the course of an aggressive investigation during the six weeks following the discovery, another nine patients were found colonized or infected.

Hospital officials immediately mobilized, according to Elizabeth Wallace, infection preventionist at Methodist Dallas, who presented a paper on the hospital's rapid response to the outbreak at the annual meeting of the Association for Professionals in Infection Control and Epidemiology (APIC).

Wallace explained that three of the cases were epidemiologically related "given their proximity in the Cardiac Care Unit, and the fact that all specimens were from the respiratory tract." Another case was found in a clinical culture from the hospital's Surgical Intensive Care Unit.

They sent isolates to the Texas Health Department for confirmation, and of those sent, 13 were determined to be hospital-acquired, and 11 were confirmed by molecular analysis as genetically identical.

 

  • All patients were placed in contact precautions, where all staff were required to wear gloves and gowns upon entry to the patient rooms and visitors were strongly urged to do so too.
  • Biweekly surveillance cultures were initiated, including endotracheal aspirate or sputum, would cultures from patients with draining wounds and rectal swabs.
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