Grupel Daniel, Borer Abraham, Yosipovich Riki, Nativ Ronit, Sagi Orli, Saidel-Odes Lisa
Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Hebrew University, Jerusalem, Israel.
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Am J Infect Control. 2025 Jan;53(1):98-104. doi: 10.1016/j.ajic.2024.08.018. Epub 2024 Aug 23.
Carbapenem-resistant Acinetobacter baumannii (CRAB) causes life-threating hospital-acquired. Due to a limited number of Intensive-Care-Unit (ICU) beds, these patients are often treated in high-dependency (HD) non-ICUs within internal-medicine wards (IMW) in Israel. We aimed to assess the effectiveness of a multilayered infection-control intervention on CRAB infection rate in IMWs, especially in its HD non-ICUs with ongoing CRAB transmission.
A quasi-experimental, before-and-after, interrupted time-series study with control outcomes. We conducted a multilayered intervention over 3.5years, which included 4 phases: (1) Pre intervention; (2) Intervention introduction: introduced enhanced environment cleaning; (3) Intervention phase 1: introduced active surveillance; (4) Intervention phase 2: introduced CRAB-positive patient cohorting, in addition to previous ongoing measures taken.
CRAB was isolated from 204 patients aged 69.8y/o ± 15.86y, 59.8% male, 34.3% had CRAB-positive clinical samples. Mean hospital length-of-stay was 30.5days, with a 30-day postdischarge mortality rate of 55.9%. Mean CRAB clinical cases decreased from 0.89 in preintervention to 0.11 at the end of phase 2, with a change in slope and level after the intervention of P = .02 (CI: -0.204 to -0.040) and P = .004 (CI: -0.013 to -0.003), respectively.
This intervention, including enhanced environment cleaning, active surveillance, and patient cohorting, successfully reduced CRAB acquisition in IMWs and their HD non-ICUs.
耐碳青霉烯类鲍曼不动杆菌（CRAB）可引发危及生命的医院获得性感染。由于重症监护病房（ICU）床位数量有限，在以色列，这些患者常在内科病房（IMW）的高依赖（HD）非ICU病房接受治疗。我们旨在评估一项多层感染控制干预措施对IMW中CRAB感染率的有效性，尤其是在持续发生CRAB传播的HD非ICU病房。
一项采用对照结果的准实验性前后对照中断时间序列研究。我们在3.5年的时间里实施了一项多层干预措施，该措施包括4个阶段：（1）干预前；（2）干预引入阶段：引入强化环境清洁；（3）干预第1阶段：引入主动监测；（4）干预第2阶段：除了之前采取的持续措施外，引入CRAB阳性患者分组。
从204名年龄为69.8岁±15.86岁的患者中分离出CRAB，其中男性占59.8%，34.3%的患者有CRAB阳性临床样本。平均住院时间为30.5天，出院后30天死亡率为55.9%。CRAB临床病例的平均数从干预前的0.89例降至第2阶段末的0.11例，干预后斜率和水平的变化分别为P = 0.02（CI：-0.204至-0.040）和P = 0.004（CI：-0.013至-0.003）。
这项包括强化环境清洁、主动监测和患者分组的干预措施成功降低了IMW及其HD非ICU病房中CRAB的感染率。
