Teamwork helps to solve infection problem at one Florida hospital

Jackson Memorial Hospital, Miami, finds a way to nearly eliminate Acinetobacter baumannii. Photo courtesy of Jackson Health System

For nearly two decades and no matter what measures it took, Jackson Memorial Hospital, Miami, struggled to prevent carbapenem-resistant Acinetobacter baumannii infections.

Even developing a set of bundled prevention interventions failed to impact infection rates. The interventions included patient screening tests upon admission to the ICU and weekly thereafter, isolation and separation of patients testing positive for A. baumannii, weekly sampling of surfaces to assess thoroughness of cleaning and hand-hygiene interventions.

But when the infection control department started to email comprehensive weekly reports on new cases to physician, hospital nursing, medical and administrative leaders, the rate of A. baumannii transmission decreased by 63 percent, according to the research team from the University of Miami Miller School of Medicine.

Overall acquisition of new cases of carbapenem-resistant A. baumannii decreased from 5.13 to 1.93 per 10,000 patient days during the period starting June 2010 through June 2013, according to a study published in the May issue of the American Journal of Infection Control.

The authors agreed that regular communication allowed the infection control department to create a sense of accountability for new cases that unified both the leadership and providers toward the common goal of decreasing new acquisitions of A. baumannii.

"The weekly reports established peer pressure and accountability across the units," says Silvia Munoz-Price, M.D., one of the lead authors of the study and medical director of the infection control unit at Jackson Memorial.

Weekly reports to hospital leadership described and interpreted the surveillance results from the previous week, including the number and location of newly discovered cases.

The reports also included results of environmental cultures obtained from bed rails, bedside tables, intravenous pumps and nursing stations, and a map indicating the location of A. baumannii-positive patients and objects.

Besides the increased communication, specific actions resulted in the decrease in cases, including an increase in environmental cleaning, early identification of colonized patients and separation between colonized and noncolonized patients, and hand-hygiene awareness campaigns.

The infection control department stopped sending the weekly email reports to hospital leadership as cases of A. baumannii became infrequent, Munoz-Price says.