Improved Cleaning Needed to Fight Off Acinetobacter Baumannii

Surfaces in intensive care units (ICUs) such as bed rails, bedside tables, and food tables need to be continuously disinfected to protect patients from Acinetobacter baumannii, a deadly pathogen that’s getting harder to ward off. Investigators with Jordan University of Science and Technology conclude that health care workers (HCWs) must continuously monitor objects near patients, including medical equipment, for the presence of A. baumannii.

“These findings underscore the need for more sophisticated and more frequent cleaning procedures of the surfaces and equipment surrounding patients, as well as for the need for constant awareness by the HCWs of potential pathogen reservoirs,” according to their findings in a pre-proof study in the in the American Journal of Infection Control. Health care professionals also need to wash their hands frequently.

The study notes that the World Health Organization labels carbapenem resistant A. baumannii (CRAB) as a critical priority for control. “Moreover, resistance of A. baumannii against the last resort antibiotics; colistin and tigecycline, has been increasingly reported worldwide,” the study states.

A. baumannii has a mortality rate of anywhere from 8% to 35%, often depending on how long an individual might be hospitalized. The study concludes that high-touched surfaces of ICUs are often contaminated with extensively resistant A. baumannii isolates.

Investigators collected 337 samples from 6 ICUs and 2 emergency units in 4 of the largest hospitals in Northern Jordan between October 2019 to March 2020. They collected 311 surface samples and 26 air samples. The surface samples were collected from blankets, bed rails, trolley handles, sheets, door handles, light switches, bedside tables, bedside table drawers, curtains, sinks, food tables, curtains, normal saline stands, and neonatal incubators. The samples were collected from occupied rooms, or rooms from which a patient had been discharged and that were cleaned.

The study states that “all obtained isolates were characterized for their antibiotic resistance phenotypes, biofilm formation capacities and were typed by multi-locus sequence typing.” A. baumannii isolates were recovered, mostly from surfaces in the internal medicine ICUs. Among the 24 isolates, 10 isolates were classified as extensively drug-resistant, harbored the blaOXA-23 like gene and able to form biofilms with varying capacities. ST2 was the most frequent sequence type, with all ST2 isolates classified as [extensively drugpresistant].”

Food tables were particularly problematic since they are frequently used by health care professionals to hold medical charts. “Our findings indicate that hand washing or hand antiseptics should be practiced by HCWs immediately after performing patient care activities,” the study states.

Sinks, too, were a problem. They’re used by health care workers, visitors, and patients. They note that sink traps are often colonized by antibiotic-resistant bacteria and that stagnant water in sinks can be a reservoir for many pathogens. “Such findings highlight the need for continuous disinfection and surveillance of sinks inside ICUs. In addition, removal of sinks,” the study states.

One of the surprises of the study was that the air samples were free of A. baumannii. “A. baumannii can stay in air and be transmitted via water droplets over short distances and several reports concerning the isolation of airborne A. baumannii from ICUs have been published…. However in our study, A. baumannii was not isolated from any of the 26 collected air samples, which could be due to the absence of active cases of A. baumannii infections in the ICUs at the time of sampling.”