Extended-spectrum ß-lactamases Klebsiella pneumoniae: multimodal infection control program in Intensive Care Units


Introduction. The aims of our study were to investigate a nosocomial spread of an extended-spectrum ?-lactamases -Klebsiella pneumoniae cluster at a University teaching hospital in Italy, to describe, and to monitor the implementation of a multimodal infection control program in two mixed ICUs. Methods. During the 1 October 2005-30 September 2006 period, 79 colonized patients have been identified. Isolates were genotyped by pulsed-field gel electrophoresis (PFGE). A mutimodal infection control program with monitoring of alcoholbased hand rub was performed in Intensive Care Units (ICU A and ICU B). Results. The epidemiological investigation and PFGE showed a horizontal transmission of the same PFGE genotype, with the isolation of the outbreak strain on the hand of one healthcare operator. Alcohol based hand rub was adopted in ICU A on 18 March 2006, in addition to hand washing with plain or antiseptic soap. ICU B did not change its hand hygiene habits. Following the implementation of the program, the incidence density rate (IDR) in ICU A fell down from 4.50 to 1.68/1000 patient days. Discussion and conclusions. Our findings confirm the important role of personnel in cross-transmission. Moreover the inbuilt control group involuntarily offered by the delaying of the intervention in ICU B has given the opportunity to verify the epidemiological association between the actual implementation of infection control practices and the outbreak control.