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Multidrug Resistant Organism outbreak in ICU, and Future Prevention

Piet Vos

A higher incidence of Multidrug-resistant organisms (MDRO) was found in the intensive care unit of Elisabeth Hospital in 2013 and 2014. Clusters of Multidrug-resistant (MDR) Enterobacter cloacae and Citrobacter freundii were found. These samples were taken from sinks in patients’ rooms. After interventions were put in place to disinfect the siphons, the situation seemed under control for a period of 6 months. However, in January 2014, 3 ICU patients were found to be colonised with an identical MDR Enterobacter cloacae. As the screening progressed, it was decided to typify the MDR Citrobacter freundii, colonisations of which were also found in patients. From the period of February 2013 until August 2014, 22 patients were infected with a MDRO. Environmental screening showed that the washbasins were infected with MDRO. This resulted in a set of MDRO procedures. 1. Hand hygiene (renew good practice) 2. Preventive, antiseptic washing of patients with 2% Chlorhexidine Gluconate (chg) washcloths sage 3. Adjusted use of sink in patients’ rooms 4. Isolation in line with regulations of infection control 5. Replacement of siphons in patients’ room; weekly disinfection of siphons with chlorine solution of 300ppm 6. Type and screen of MDRO at admittance and discharge The purpose of the research and the set of measurements put in place was to halt the spread of MDR Enterobacter cloacae and MDR Citrobacter freundii from sink to patient and from patient to patient. The research took place from September 2014 until March 2015. The measurements taken resulted in a halt of the outbreak. Spreading of identical MDRO was no longer detected.