An Outbreak of Ventilator Associated Pneumonia Caused by Carbapenem Resistant Acinetobacter baumannii in an Intensive Care Unit: Lessons Learned for Better Infection Prevention Practices

Background: Acinetobacter baumannii is a known opportunistic pathogen that act as a source of life threatening healthcare associated infections (HAIs) and outbreaks. The aim of the study was to describe the events, management and the control of ventilator associated pneumonia (VAP) outbreak that occurred in intensive care unit (ICU) of a tertiary care hospital caused by carbapenem resistant A.baumannii (CRAB). Methods: Total five case patients admitted in intensive care unit presented with ventilator-associated pneumonia. Respiratory secretions from patients were processed for microbiological culture. The isolates recovered were identified by using gram stain morphology and the Vitek2 compact system (bioMerieux, France). Hypothesis made and investigation of an outbreak was carried out. Discussion with ancillary staff and environmental surveillance done. Infection control practices were evaluated and appropriate measures taken. Results: Index case presented with ventilator-associated pneumonia caused by CRABat the time of admission. Thereafter, five patients developed ventilator-associated pneumonia. Carbapenem resistant A.baumannii isolated in clinically significant cultures. All patients managed with strict contact precautions until discharge. Of the environmental samples, one sample obtained from the monitor screen beside the bed of an index case yielded growth of carbapenem resistant A.baumannii. Other non-critical surfaces showed contamination with mixed bacterial flora. The main reason of outbreak was breach in cleaning and disinfection protocols. Corrective and preventive measures taken accordingly. Conclusions: An integrated approach of epidemiological and microbiological data along with strict infection control measures were crucial to cut down the outbreak. The distinguishing characteristics of this outbreak was introduction of automated disinfectant dilutor pumps and positive impact of educational sessions conducted for HCWs.