American Journal of Epidemiology Vol. 132, No. 4: 723-733
Copyright © 1990 by The Johns Hopkins University School of Hygiene and Public Health
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EPIDEMIC BACTEREMIA DUE TO ACINETOBACTER BAUMANNII IN FIVE INTENSIVE CARE UNITS
1,
1Hospital Infections Program, Centers for Disease Control Atlanta, GA
2State Department of Health Trenton, NJ
3Department of Community Health, University of Medicine and Dentistry of New Jersey New Brunswick, NJ
4Departments of Medicine and Pathology, University of Medicine and Dentistry of New Jersey New Brunswick, NJ
Reprint requests to Hospital Infections Program, Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA 30333.
From March 5, 1986 to September 4, 1987, Acinetobacter baumannii (AB) was isolated from blood or vascular catheter-tip cultures of 75 patients in five intensive care units at a hospital in New Jersey. To identify risk factors for AB bacteremia in the intensive care units, a case-control study was conducted. Characteristics of 72 case-patients were compared with those of 37 controls. Case-patients were more likely than controls to have had peripheral arterial catheters (odds ratio (OR)= 7.0, p < 0.001), mechanical ventilation (OR= 5.8, p < 0.001), hyperali-mentation (OR= 5.7, p < 0.001), or pulmonary arterial catheters (OR= 3.9, p < 0.001). Arterial catheters were used with reusable pressure transducers for intravascular pressure monitoring. A logistic regression analysis identified four independent risk factors: transducers, ventilation, hyperalimentation, and days of transducer use at an insertion site. The strongest influence on the risk of AB bacteremia was exerted by number of days of transducer usage. Cultures of 70 transducer diaphragms or domes, 42 in-use and 28 in-storage, were positive for AB in 21% and 46%, respectively. Plasmid analysis showed that patient blood cultures and transducer isolates were identical. Transducers were wiped with alcohol in the units between patient uses. Since reusable transducers appeared to be the source of this outbreak, it is recommended that reusable transducers receive either high level disinfection or sterilization between patient uses.
Acinetobacter; bacteremia; cross infection; equipment safety; intensive care units
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