The effect of temporary closure and enhanced terminal disinfection using aerosolized hydrogen peroxide of an open-bay intensive care unit on the acquisition of extensively drug-resistant Acinetobacter baumannii

Abstract

Background: At Makassed Hospital's open-bay intensive care unit (ICU), enhanced terminal disinfection (ETD) using hydrogen peroxide (H₂O₂) 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 H₂O₂ 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.

Methods: 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.

Results: 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 H₂O₂.

Conclusion: Contact pressure, mechanical ventilation, and presence of a wound were RFA of XDR-AB. Temporary closure of the ICU with ETD using aerosolized H₂O₂ 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.

Keywords: Contact pressure; Enhanced terminal disinfection; Extensively drug-resistant Acinetobacter baumannii; Hydrogen peroxide; Intensive care unit; Lebanon; Open-bay.

Fig. 1

The number of patient days in the open-bay intensive care unit (ICU) of our facility per each numerical week after enhanced terminal disinfection (ETD) during the study period

Fig. 2

Incidence rate of extensively-drug resistant Acinetobacter baumannii (XDR-AB) acquisition (number of cases who had a positive culture per 1000 patient days) in the open-bay intensive care unit (ICU) of our facility per each numerical week after enhanced terminal disinfection (ETD). N.B. -Each patient, who resided in the ICU during the corresponding numerical week, was counted once per each numerical week depending on the date of acquisition only and it was not cumulative. -The incidence rate of XDR-AB was calculated from Week 1 to Week 16 after ETD since the number of patient days per week was > 50 days (refer to Figure-1).