Outbreak Investigation, Public Health and Health Policy
Background : Pan-nonsusceptible (pan-NS) organisms require aggressive containment per current guidance. On January 1, 2018, the state public health laboratory (SPHL) alerted the state health department (SHD) to a pan-NS Acinetobacter baumannii at Hospital A. Patient A was admitted to Hospital A from a skilled nursing facility with ventilated residents (vSNF) and shared a bathroom with patient B, who later developed pan-NS A. baumannii infection. Prior to the vSNF, patient A was admitted at a long-term acute care hospital (LTACH). The SHD in conjunction with the Centers for Disease Control and Prevention (CDC) and the facilities identified and contained transmission over the next six months.
Methods : SHD infection preventionists conducted in-person infection control assessments and addressed gaps with written feedback and phone calls. Admission screening and every two week point prevalence surveys (PPS) were done at the LTACH and vSNF. PPS continued until two consecutive negative rounds with no new cases. Screening was performed from rectal, sputum and wound specimens. Pan-NS cases demonstrated intermediate or resistant interpretations to all antibiotics tested; multidrug-resistant cases showed susceptibility to one antibiotic tested. Isolates were sent to CDC for whole genome sequencing (WGS) and OXA-23 testing.
Results : During January 31–June 27, 2018, the vSNF and LTACH performed six and ten PPS, respectively. PPS and admission screens identified 12 cases, eight of which had OXA-23. WGS showed molecular evidence of transmission in the vSNF. SHD found no hand hygiene monitoring, no contact precaution signage, inconsistent use of personal protective equipment, and inadequate disinfection in the vSNF. LTACH observations included inadequate equipment disinfection. Sustained implementation of recommended infection prevention practices was observed. In June, both facilities had cessation of transmission.
Conclusions : An effective containment response to a multi-facility outbreak was facilitated by the SHD, SPHL, CDC and the impacted facilities.