A. Baumannii policy paper katie and brittany

Policy for Proper Quarantine and Hygienic Practices and Procedures for Preventing and Treating Acinetobacter Baumannii Infections
By: Brittany Frisch and Katie Rasmussen, Board of Directors Members at Mercy Medical Center

Gram-negative , aerobic, hydrophilic, nonmotile, nonfermentative, coccobacilli Acinetobacter Baumannii is an increasing problem in hospitals throughout the world (5). Out of about 21 different strains of Acinetobacter, A. Baumannii is the species frequently found on humans (3). This is significant because it is also found to be the species of the most importance in our clinics. A. Baumannii is most notably known for its roll in generating nosocomial infections, because it is the main species associated with this specific type of infection (2, 4). Patients with A. Baumannii usually contract urinary tract infections and suffer from ventilator-associated pneumonia (2). This bacterium is also associated with skin and soft tissue infections as well as abdominal and nervous system infections (2). While these infections are not as common they still pose a major threat to patients. There have been infections reported from Europe, Asia, Northern and Southern America, as well as Tahiti and the South Pacific (2). This is to be expected of A. Baumannii because it is commonly found in various environments, but usually favors dry humid settings (5)
Most gram-negative bacteria cannot survive in dry environments and surfaces. This is a key feature that makes A. Baumannii so unique. Another unique adaptation, along with its unusual ability to survive in and on dry environments, is its mean survival time in and on these environments and surfaces. (5) A. Baumannii has been found to be able to survive on dry surfaces for roughly 27 days. Over a period of 9 weeks its ability to survive is decreased slightly, but remaines at that decreased level for approximately a year finally dying after the 49th week. (5) A. Baumannii also has the ability to survive in the air for relatively 157 days in an environment that has a constant humidity of 31%. (5)
A. Baumannii is effectively resistant to many antibiotic agents including β-lactams (3). This bacterium usually occurs in imunosupressed patients, diseased patients, and those treated with many antibiotics (2). This resistance to β-lactams is a result from the overproduction of cephalosporinase in the bacteria. (3) The alteration of specific proteins and the activity of efflux pumps further diminish A. Baumannii’s susceptibility to β-lactams. (2) Although A. Baumannii is resistant to most antibiotics it is susceptible to carbapenems, specifically meropenem and imipenem. (3) Due to the resistance of A. Baumannii to almost all antibiotics study’s focusing on the susceptibility of this bacterium against specific antimicrobial peptides have been instigated. Unfortunately, the high cost of peptides, manufacturing, delivery, and toxicity problems need to be overcome before this treatment can be implemented in the clinical environment. (2)

This policy will implement proper hand washing and quarantine procedures for dealing with patients infected with A. Baumannii.
• All patients found to be infected with A. Baumannii are to be immediately quarantined to their own private room. Accesses to quarantined rooms are to be restricted to authorized personal only. All employees must be fitted with face masks prior to entering quarantined room and the mask must be disposed of in hazardous waste disposal immediately following departure from the room. All employees must also wear gloves at all times when in quarantined rooms. Gloves must always be worn and only removed to wash hands after exposure followed by the immediate addition of new clean gloves.
• Hands are to be washed prior to entering and immediately following departure from quarantined room. The proper hand washing guidelines that are to be used are those outlined by 2005 WHO Guidelines for Hand Hygiene in Health Care (1):
I. Wash hands with soap and water when visibly dirty or contaminated with proteinaceous material, or visibly soiled with blood or other body fluids, or if exposure to potential spore-forming organisms is strongly suspected or proven, or after using the restroom
II. Use an alcohol-based hand rub for routine hand antisepsis.
III. Perform hand hygiene before and after contact with patients, after removing gloves, before handling an invasive device for patient care, regardless of whether or not gloves are used, after contact with bodily fluids, excretions, mucous membranes, non-intact skin, or wound dressings, and after contact with inanimate objects in the immediate vicinity of the patient
• The proper hand washing techniques that are to be used are those outlined by the 2005 WHO Guidelines for Hand Hygiene in Health Care (1):
1. When washing hands with soap and water, wet hands with water (avoid using hot water) and apply the amount of product necessary to cover all surfaces. Vigorously perform rotational hand rubbing on both hand palms and backs, interlace and interlock fingers to cover all surfaces.
2. Rinse hands with water and dry thoroughly with single-use towel. Use running and clean water whenever possible. Use towel to turn off tap/faucet
3. Make sure hands are dry. Use a method that does not recontaminate hands.

• Extensive hand washing is not necessary to combat A. Baumannii infections.
o Hand washing is vital in order to prevent the spread of A. Baumannnii. This is due to the fact that during outbreaks skin and rectal samples have been identified as being the main source of transmission and colonization. (5) The widespread of A. Baumannii throughout hospitals has been directly linked to cross-contamination via the hands of staff members working from patient to patient. (4) While hand washing is encouraged throughout all hospitals it is hardly ever severely enforced. That is why it is imperative that a strict hand washing policy is implemented when dealing with this infection.
• Quarantining isn’t necessary for treating A. Baummanni infections.
o Aerial dissemination has been found to be another route for transmission of the A. Baumannii. Various environmental sources have been identified in the transmission of A. Baumannii throughout hospitals. The environmental sources include room humidifiers, air conditioning equipment, various bed components, curtains, and patient ventilation equipment. (5) Other sources of preventative treatments are likely to be ineffective in preventing the aerial dissemination of the bacterium; therefore, the isolation of contaminated patients is the only effective treatment to prevent the transmission of this bacterium throughout the hospital. (5)

A. Baumannii is a potentially serious infection that once enters a hospital has the ability to spread rapidly moving from patient to patient as well as infecting staff. It is a very unique bacteria, surviving and thriving for long periods of time in many different environments. It is usually falsely identified as Staphylococcus Aureus because it is resistant to multiple antibiotics. However, the main difference between the two is that their epidemiologies are different. S. Aureus is passed from person to person, while A. Baumannii is also passed in this way it also has been linked to spread through environmental sources and reservoirs and through aerial dissemination (5). Therefore, preventative measures used for S. Aureus cannot be used to treat and prevent A. Baumannii as has been done previously (5). This is why it is so important to produce procedures and policies directly associated with the treatment and prevention of A. Baumannii.

(1) WHO, World Alliance for Patient Safety: WHO Guidelines on Hand Hygeine in Health Care, 2006.
(2) Perez F., Global Challenge of Multidrug-Resistant Acinetobacter baumannii, Antimicrobial Agents and Chemotherapy, October 2007.
(3) Yu Mi Lim, Distinct Antimicrobial Resistance Patterns and Antimicrobial Resistance-Harboring Genes According to Genomic Species of Acinetobacter Isolates, Journal of Clinical Microbiology, March 2007.
(4) Kilic, A., Acinetobacter septicus sp. nov. Association with a Nosocomial Outbreak of Bacteremia in a Neonatal Intensive Care Unit, Journal of Clinical Microbiology, March 2008
(5) Beggs, C.B., Acinetobacter spp. and the Clinical Environment, Indoor Built Environment, 2006.

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