O123 Oral Session Outbreaks of MDR-Gram-negative bacteria: what works and what does not work? A VENTILATOR-FOCUSED INTERVENTION TO REDUCE THE RATE OF ACINETOBACTER BAUMANNII INFECTION AMONG VENTILATED PATIENTS R. Cohen1, Z. Shimoni2, R. Ghara3, R. Ram4, R. Ben-Ami5 1Infectious Diseases Unit, Sanz Medical Center - and Bruce Rappaport Faculty of Medicine Technion Institute of Technology , , Israel ; 2Internal Medicine B, Sanz Medical Center - Laniado Hospital and Bruce Rappaport Faculty of Medicine Technion Israel Institute of Technology Haifa, Netanya, Israel ; 3Biomedical engineering, Sanz Medical Center - Laniado Hospital and Bruce Rappaport Faculty of Medicine Technion Israel Institute of Technology Haifa, Netanya, Israel ; 4Bone marrow transplantation unit, Rabin Medical Center and Tel-Aviv University, Petach-Tikva, Israel ; 5Infectious Diseases Unit, Tel-Aviv Sourasky Medical Center and Tel-Aviv University, Tel-Aviv, Israel

Objectives

Acinetobacter baumannii (AB) is a leading cause of ventilator-associated pneumonia (VAP). Outbreaks of AB-VAP have been traced dow n to contaminated respiratory care equipment. How ever, clear evidence-based guidance on optimal care of ventilator equipment is lacking. We report on the impact of an intervention to optimize ventilator equipment care on the incidence of AB-VAP at our hospital.

Methods

We performed an interrupted-time series study in a 400-bed hospital betw een January 1st 2012 and March 31st 2013. We included adults w ho w ere ventilated for at least 3 days and had baseline sputum cultures. The intervention w as implemented betw een April and June 2012 and included: 1. Exchange of breathing circuits and ventilator external bacterial filters every 7-14 days; 2. Replacement of all internal bacterial filters follow ed by routine autoclave sterilization every 4-8 w eeks; 3. Discontinuing the use of external filters in the inspiratory inlet; 4. Daily replacement of endotracheal heat and moisture exchanger filters because of frequent soiling; 5. Metered-dose inhalers w ere not to be disconnected from the endotracheal tube unless inhalation w as no longer needed or w hen soiled, in w hich case they w ere discarded. Reuse of metered-dose inhalers betw een patients w as prohibited. We analyzed the intervention effect on the rate and timing of nosocomial pathogen acquisition and on clinical outcomes.

Results

The study cohort included 321 patients: 136 and 185 patients pre- and post-intervention, respectively. There w ere no significant differences in baseline demographic and clinical characteristics betw een the tw o groups. There w as a statistically significant reduction in the acquisition of nosocomial AB follow ing the intervention: 16% (30/185) vs. 33% (45/136), odds ratio 0.39, 95% CI 0.23-0.67, P=0.0008. Additionally, the median time to acquisition of AB w as significantly longer post intervention (59 vs. 21 days, hazard ratio 0.37, 95% CI 0.21-0.55, P<0.0001; Figure 1). There w as no difference in the acquisition rate of other nosocomial bacteria commonly causing VAP. AB-VAP rate w as reduced significantly post-intervention: 12% (23/185) vs. 23% (31/136), odds ratio 0.48, 95% CI 0.26-0.86, P=0.016. There w as no difference in number of ventilation and hospitalization days and in crude mortality betw een the pre and post intervention periods.

Conclusions

Routine replacement and sterilization of ventilator-related equipment can significantly decrease nosocomial acquisition of AB and related adverse outcomes among ventilated patients. More strict evidence based guidelines on ventilator equipment care and maintenance are required.