Intervention to limit transmission of extremely drug-resistant Acinetobacter baumannii in patients who underwent surgery.

TO THE EDITOR—Extremely drug-resistant (XDR) Acinetobacter baumannii is an opportunistic gram-negative pathogen with increasing relevance worldwide [1]. Although outbreaks of XDR A. baumannii have been reported in several settings around the world [2–4], infection control interventions to limit XDR A. baumannii transmission among patients undergoing surgical procedures have been rarely reported. We described an infection control intervention to limit the transmission of XDR A. baumannii transmission among postoperative patients. An increased incidence of XDR A. baumannii among postoperative patients was detected at Thammasat University Hospital, Pathumthani, Thailand. Between 14 October 2010 and 20 December 2010, 24 patients had XDR A. baumannii isolated from clinical cultures within 48 hours after surgery (Figure 1). On 21 December 2010, the hospital epidemiologist was notified and an investigation was initiated. An initial investigation of the operating theater (OT) and general surgical units identified several lapses in infection control practices, including (1) lack of adequate communication among surgical and OT staff about known cases of XDR A. baumannii infection and/or colonization, (2) inadequate contact isolation for XDR A. baumannii infection and/or colonization cases, and (3) inadequate environmental cleaning, including improper cleaning in the OT (eg, lack of extra OT cleaning after operating on patients with XDR A. baumannii infection and/or colonization) and on the general surgical units. Although no point source was detected, cultures of several high-touch items in the OT (eg, monitor button, bed lever) and the general surgical units (eg, doorknob, bed rails, dressing carts) grew XDR A. baumannii. Several infection control interventions were implemented, including (1) educating staff in both areas on proper hand hygiene and contact isolation; (2) creating a communication process between OT, general surgical unit, and infection prevention staff to identify colonized and/ or infected patients; (3) limiting transfer of case patients within the same surgical unit; and (4) implementing intensified environmental cleaning of the OT and general surgical units. Monitoring of adherence