Management and control of a carbapenem-resistant Acinetobacter baumannii outbreak in an intensive care unit

Objective. - We had for aim to describe the identification and management of a 14-clonal carbapenem-resistant Acinetobacter baumannii (CRAB) outbreak, following admission of a known CRAB-infected patient in an ICU. Methods. - We reviewed the carriers' files and outbreak management procedures. Results. - The index patient was admitted with strict isolation precautions. The outbreak started 2 months after his discharge. It persisted despite reinforcement of strict isolation precautions, staff and patient cohorting, and extensive environmental decontamination including 2 rounds of routine terminal cleaning and disinfection or 1 round of cleaning and disinfection followed by hydrogen peroxide treatment. A second epidemic peak, after 4 weeks without any case, led to another wide environmental sampling and decontamination rounds. The source of the CRAB outbreak was suspected to be the blood pressure cuffs Velcro. Switching to cuffs submersible in a disinfectant stopped the outbreak. Conclusions. - CRAB outbreaks are difficult to manage and sources of persistent colonization can be unexpected. (C) 2014 Published by Elsevier Masson SAS.