Impact of environmental cleaning on the colonization and infection rates of multidrug-resistant Acinetobacter baumannii in patients within the intensive care unit in a tertiary hospital
Abstract Objective: To continuously evaluate the effect of environmental cleaning on the colonization and infection rates of multidrug-resistant Acinetobacter baumannii (MDR-AB) in the patients within a intensive care unit (ICU). Methods: Environmental cleaning on the high-touch clinical surfaces (HTCS) within a comprehensive ICU was evaluated through monitoring fluorescent marks. In the meanwhile, samples from the HTCS and inpatient were collected and sent for bacterial culture and identification. The drug susceptibility testing was further implemented to monitor the prevalence of MDR-AB. The genetic relatedness of MDR-AB collected either from the HTCS or inpatient was analyzed by pulsed field gel electrophoresis (PFGE) when an outbreak was doubted. Results: From the beginning to the end of 2013, the clearance rate of fluorescence marks on the environmental surfaces within ICUs significantly increased from 21.9% to 85.7%, and accordingly the colonization and infection rates of MDR-AB decreased from 16.5‰ to 6.6‰ and 7.4‰ to 2.8‰, respectively. However, during the year 2014, because of frequent change and movement of cleaning workers, the clearance rate of fluorescence marks decreased below 50%, and the overall colonization and infection rates of MDR-AB correspondingly increased from 9.1‰ to 11.1‰, 1.5‰ to 3.9‰, respectively. PFGE displayed a genetic relatedness between the MDR-AB strains analyzed, indicating a dissemination of MDR-AB during the surveillance period. Conclusion: For MDR-AB, both the colonization rates and the infection rates of the patients within ICUs can be directly influenced by environmental cleaning, and the bad environmental cleaning may result in MDR-AB outbreak. The invisible fluorescence labelling is an effective and convenient method to continuously monitor environmental cleaning within hospitals.