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Outbreak Investigation Report

This document summarizes an outbreak investigation of multidrug-resistant Acinetobacter baumannii at a hospital. Four cases were reported in the surgical intensive care unit in November 2019. Environmental and hand cultures found that humidifiers, ambu bags, and healthcare workers' hands in the ICU were positive for A. baumannii. To control the outbreak, infected equipment was replaced, hand hygiene practices were emphasized, and repeat hand cultures were recommended.

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Prabhat Kumar
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182 views2 pages

Outbreak Investigation Report

This document summarizes an outbreak investigation of multidrug-resistant Acinetobacter baumannii at a hospital. Four cases were reported in the surgical intensive care unit in November 2019. Environmental and hand cultures found that humidifiers, ambu bags, and healthcare workers' hands in the ICU were positive for A. baumannii. To control the outbreak, infected equipment was replaced, hand hygiene practices were emphasized, and repeat hand cultures were recommended.

Uploaded by

Prabhat Kumar
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© © All Rights Reserved
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Outbreak investigation report of Acinetobacter Baumannii

Introduction

Multidrug-Resistant Acinetobacter Baumannii has emerged worldwide as an important health care–


associated pathogen, causing infections such as ventilator associated pneumonia, bloodstream infections,
and wound infections. The bacteria can survive in the environment for months, thus making transmission
difficult to prevent and control. A. baumannii can colonize the human skin and gastrointestinal tract and
thereby can cause HAIs. Many Acinetobacter isolates demonstrate extensive resistance to antimicrobial
agents, including carbapenems, which greatly complicates treatment of these infections.

Outbreak Description:

MDRO Acinetobacter Baumannii isolation was reported in our hospital in November 2019. A total of 4
cases were reported in the month. All Patients are from SICU. Infection Control team was informed about
the same and environmental as well as hand cultures are taken to identify the root cause.

Outbreak Investigation

Swab cultures are taken from ventilators, Humidifiers, Suction Jars, Ambu Bag, Bedside railing, floors
and wall of SICU and ER both. Emergency department is added in the study because the pathway of
positive patients transfer started from ER.

Transfer Date Result


S.
Name & IPD DOA
No Date Intubatio Sample
From To Extubation Reporting
n Collection
3/11/19
Emg  SICU 
 Premlata
 SIC 3/11/19  3/11/19 5/11/19   5/11/19 7/11/19  A.
 1 (4972)  3/11/19 OT  Baumannii 
  U        
      3/11/19        
 
 OT SICU   
             
   SIC 6/11/19
Dis 
U
29/10/1
OPD S.W 9
30/10/19 31/10/19
30/10/1
SW OT 9
30/10/1 A.
Ram Niwas OT SICU 9
8/11/19 11/11/19
29/10/1 Baumannii 
2 9 31/10/1
13/11/19 15/11/19
 
(4693) SICU S.W 9
12/11/19 16/11/19
4/12/19
S.W SICU 4/12/19 4/12/19
Expire 4/12/19
SICU
d
Roshni Emg SICU 9/11/19 A.
3 (5270) 9/11/19
Expire 15/11/1 9/11/19 15/11/19 13/11/19 15/11/19 Baumannii
SICU 9
d
15/11/1
Emg SICU 9
Suresh SICU OT
15/11/1
A.
15/11/1 9
4 Kumar 9 15/11/1 15/11/19 16/11/19
20/11/19 23/11/19 Baumannii
(5538) OT SICU 9
22/11/1
SICU S.W 9
26/11/1
S.W Dis 9

Out of them following samples are found Positive:

S. No Source of Sample Report Organism


1 Humidifier(SICU) Positive Gram Negative Bacilli
2 Ambu bag (SICU) Positive Gram Negative Bacilli
3 Hand Culture Positive Gram Negative Bacilli
(S/N Priyanka SICU)
(GDA Rambilas SICU) Positive Gram Negative Bacilli + Gram
Positive Bacilli

Conclusion & Recommendation

As discussed in HIC meeting on following measures were taken to mitigate the outbreak:

1. Replacement of infected Humidifier and Ambu bag.


2. Staff was advised to follow hand hygiene practices strictly.
3. Repeat Hand Cultures to be sent.

Prepared By: Approved By:

Ms. Ankita Dr. Neeraj Nagar


ICN MS

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