Division of Infectious Diseases, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon.
Division of Infectious Diseases, Hôtel Dieu de France, Beirut, Lebanon.
Antimicrob Resist Infect Control. 2020 Jul 14;9(1):108. doi: 10.1186/s13756-020-00772-z.
At Makassed Hospital's open-bay intensive care unit (ICU), enhanced terminal disinfection (ETD) using hydrogen peroxide (HO) was performed without a predefined schedule in extensively-drug-resistant Acinetobacter baumannii (XDR-AB) outbreaks. In this study, we aimed to check for the value of the temporary closure of the ICU and the use of ETD with aerosolized HO and Ag on minimizing the rate of XDR-AB acquisition in patients admitted to the ICU of our facility, which might consequently help us determine the optimal schedule for such procedure in this unit.
This is a retrospective medical file review of patients admitted to the ICU between January 2016 and May 2018. We divided this period into numerical weeks (NW) after each closure and ETD episode. Risk factors of acquisition (RFA) were determined by comparing the characteristics of patients who acquired XDR-AB to those who didn't. The proportion of patients residing in each NW was included in the RFA analysis.
Out of 335 patients, 13% acquired XDR-AB. The overall incidence of XDR-AB acquisition was 14.6 cases/1000 patient days. RFA were XDR-AB contact pressure ≥ 3 days [Odds Ratio (OR) = 9.86, 95% Confidence Interval (CI) (3.65-26.64), P < 0.0001)], mechanical ventilation [OR = 4.99, 95%CI (1.76-14.15), P = 0.002)], and having a wound [OR = 3.72, 95%CI (0.99-13.96), P = 0.05)]. Patients who stayed during NW 7,11 and 14 were at risk of acquisition where the odds significantly increased by 6.5, 9.7 and 14.4 folds respectively (P = 0.03,0.01, and 0.01, respectively). We considered NW 7 as the most suitable time for temporary closure of the ICU and ETD with aerosolized HO.
Contact pressure, mechanical ventilation, and presence of a wound were RFA of XDR-AB. Temporary closure of the ICU with ETD using aerosolized HO decreased the rate of XDR-AB acquisition, yet this effect fades away with time. The ETD was shown to be most efficiently done when repeated every 7 calendar weeks in our open-bay ICU as part of a prevention bundle.
在 Makassed 医院开放式重症监护病房（ICU），针对广泛耐药鲍曼不动杆菌（XDR-AB）爆发，采用过氧化氢（HO）进行强化终末消毒（ETD），但没有预先设定时间表。在这项研究中，我们旨在检查 ICU 临时关闭和使用雾化 HO 和 Ag 进行 ETD 是否可以降低我们医院 ICU 收治的患者中 XDR-AB 的获得率，这有助于我们确定该单位中该程序的最佳时间表。
这是对 2016 年 1 月至 2018 年 5 月期间入住 ICU 的患者的回顾性病历审查。我们将这一时期分为每次关闭和 ETD 后以数字周（NW）表示。通过比较获得 XDR-AB 的患者和未获得 XDR-AB 的患者的特征，确定获得的危险因素（RFA）。将 NW 中每位患者的比例纳入 RFA 分析。
335 名患者中有 13%获得了 XDR-AB。XDR-AB 的总体获得率为 14.6 例/1000 患者天。RFA 为 XDR-AB 接触压力≥3 天[优势比（OR）=9.86，95%置信区间（CI）（3.65-26.64），P<0.0001]、机械通气[OR=4.99，95%CI（1.76-14.15），P=0.002]和有伤口[OR=3.72，95%CI（0.99-13.96），P=0.05]。NW 7、11 和 14 期间住院的患者有获得 XDR-AB 的风险，风险显著增加 6.5、9.7 和 14.4 倍（P=0.03、0.01 和 0.01）。我们认为 NW 7 是 ICU 临时关闭和使用雾化 HO 进行 ETD 的最佳时机。
接触压力、机械通气和伤口存在是 XDR-AB 的 RFA。在开放式 ICU 中，使用雾化 HO 进行 ICU 临时关闭和 ETD 可降低 XDR-AB 的获得率，但这种效果会随着时间的推移而消失。在我们的开放式 ICU 中，作为预防包的一部分，每 7 个日历周重复进行 ETD，效果最佳。
