04/16/2013 // Concord, CA, USA // LifeCare123 // Greg Vigna, MD, JD // (press release)
Dr. Greg Vigna M.D., J., San Francisco Injury Lawyer investigates the growing threat of multi-drug resistant (MDR) Acinetobacter to hospitalized and institutionalized patients.
In the past, Acinetobacter infections have sporadically been identified in the hospitalized patients in the United States. Between 1987 and 1996 there were only an average of 345 hospital acquired Acinetobacter infections reported each year to the U.S. National Nosocomial Infections Surveillance System. Since 2007, Acinetobacter infections are one of the most common gram-negative, drug resistant hospital infections in the United States, and studies have shown that there is an increased mortality and length of stay in patients with a MDR Acinetobacter. Not only does it infect healthy individuals it is a direct threat to those who have chronic disabling conditions that require long-term hospitalization and rehabilitation such as spinal cord injuries, traumatic brain injury, ventilator dependent patients, and burn patients.
Acinetobacter has been found to persist in the hospital environment in bedside cabinets, telephone, computer keyboards, sinks, patient charts, ventilators, and the hospital staff. Once there is an outbreak, there is often difficulty in finding the source. Acinetobacter has a very long survival time of up to 11 days on Formica and 12 days on stainless steel and up to four months on dry surfaces. Acinetobacter is a ubiquitous organism with potential to live in multiple environments. It does pose a significant threat in a hospital environment and can be brought into a facility via multiple routes. ?Once present in the hospital environment, Acinetobacter may be difficult to eradicate. A study showed that hospital bed rails could harbor Acinetobacter for up to nine days after discharge of an infected patient. Acinetobacter has been demonstrated on various surfaces including washbasins, bedside tables, sinks, ventilators, pillows, mattresses, trolleys, and resuscitation equipment.
Acinetobacter outbreaks in the hospital and institutional setting have been reported with increasing frequency. It is clear that best practice management must be instituted in both the hospital setting but in long-term rehabilitation facilities that care for those who require long term rehabilitation and custodial care. All these studies suggest that decontamination must be an essential measure in the control of this bacteria as well as Standard Precautions and Transmission Precautions. Best practice protocols have been developed by Johns Hopkins Medical Center but these have been not widely applied in a majority of health care facilities because of cost and the difficulty in implementing this risk management tool.
A retrospective study in a very large teaching hospital in Spain showed that greater than ninety percent of Acinetobacter infections were hospital acquired with 39 percent being respiratory infections, 24 percent being abscesses and 23 percent urinary tract infections. Acinetobacter has been reported in meningitis, endocarditis (heart infections), and osteomyelitis (bone infection). MDR Acinetobacter infections have been shown to increased ICU length of stay and prolong the length of hospitalized patients in two Baltimore hospitals. In a burn unit of a public teaching hospital patients with a MDR Acinetobacter cost the hospital over $98,000 more than patients without a MDR Acinetobacter with identical burn severity.
From my experience of providing care for patients in a variety of settings including acute care hospitals, acute rehabilitation hospitals, long-term acute hospitals, and skilled nursing facilities there is a general lack of implementation of the best practice protocols to prevent outbreaks. From my experience the Joint Commission has not broadly recommended the best practices as implemented by Johns Hopkins and have focused their evaluations on other matters. MDR Acinetobacter is here to stay and the federal government must mandate implementation as condition for payment. Best practice protocols across all patient care facilities is necessary and there must be adequate funding to educate care givers, families, health care professionals, and ancillary staff to prevent the increased morbidity and mortality of this dangerous organism.
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