Prompt actions halt alarming infection outbreak at Dallas hospital

Methodist Dallas Medical Center identified an unusual cluster of drug-resistant Acinetobacter during a one-week period in 2009 and conducted an immediate investigation. Through rapid response and comprehensive interventions, the hospital was able to arrest the outbreak in a much shorter time-frame compared with most other reported outbreaks of this bacterium that have been known to last for months or years.

Infection control staff at the 515-bed hospital, in consultation with the Hospital Epidemiologist, Dr. Zakir Shaikh, quickly concluded that the known cases met the criteria for full epidemiological investigation and began an aggressive campaign of surveillance and intervention. All current and incoming patients were tested for Acinetobacter, and in affected units, every patient was put under contact precautions -- where staff is required to don gloves and gowns upon entry to the patient's room, and visitors are encouraged to do the same. The hospital also instituted regular meetings between all of the departments involved with caring for these patients; administrators, physicians, nurses, lab technicians, environmental services and physical plant staff were all consulted to control the outbreak.

"A responsive hospital administration including a CEO who supports our program, close contact with local and state health departments, and collaborative teamwork between departments were responsible for our success," said Beth Wallace, MPH, CIC, infection preventionist at Methodist Dallas Medical Center who presented the findings at the APIC conference. "Our experience shows that controlling Acinetobacter outbreaks requires effective surveillance, dedicated teamwork and rapid intervention with application of best practices in a consistent and timely manner."

Acinetobacter baumannii is a species of gram-negative bacteria that has caused outbreaks of infection in healthcare facilities over the last decade and considerable concern in the medical community. Infections from this pathogen primarily occur in very ill, wounded or immunocompromised patients. The germ can remain on wet or dry surfaces for longer than most other organisms, making it harder to eradicate. As is the case with other, more well-known healthcare-associated infections, such as MRSA, Acinetobacter has effectively developed resistance to most common antibiotics and continues to evolve against the medicines used to fight its infections. Though much literature on the topic has been published in the last five years, there are no agreed-upon prevalence, morbidity or mortality figures for the infection.

"Methodist Health System makes infection prevention a priority and has the fully recommended infection prevention resources and staffing in all of their facilities," said Wallace. "Because we have adequate resources in terms of staffing and technology, we were able to keep a close eye on this and act quickly."

"With outbreaks of pan-resistant Acinetobacter baumannii and other multi-drug resistant organisms on the rise, it is absolutely essential that infection prevention departments be fully staffed and adequately resourced," said APIC President Cathryn Murphy, RN, PhD, CIC. "Methodist Dallas Medical Center was proactive in their approach, responding rapidly and mobilizing an interdisciplinary team to control the outbreak. The experiences of infection preventionists such as Ms. Wallace serve as practical guidance for healthcare professionals combating multi-drug resistant pathogens. Their experience is a powerful reminder that aggressive infection prevention programs are required to protect patients and save lives."

Wallace presented an abstract on her facility's experiences at APIC's Annual Conference. The meeting, which is the largest annual gathering of infection preventionists from around the world, takes place July 11-15 in New Orleans.