Healthcare-acquired infections caused by multidrug-resistant organisms like Acinetobacter baumannii pose significant threats to peak healthcare delivery, augmenting both morbidity, mortality, and healthcare costs. Transmission can occur in a myriad of ways, from contact with healthcare personnel to interaction with contaminated surfaces or equipment. To quell this concern, infection prevention and control (IPC) measures like hand hygiene, personal protective equipment usage, dress code adherence, environmental cleaning, and adequate staffing are vital. Despite the proven efficacy of improved hand hygiene in reducing the transmission of multidrug-resistant organisms, the required compliance levels to preclude outbreaks in high-risk settings such as burn intensive care units remain ambiguous.
Set against this backdrop, this article delves into an 11-year analysis of routine hygiene compliance observations at a burn ICU in Sweden. Here, focus is placed on a composite measure of non-compliance embracing hand hygiene, gloves and apron use, and dress-code adherence to understand whether shifts in non-compliance patterns aligned with two A. baumannii outbreaks and whether these data could proactively support IPC interventions.
The Burn Centre, featuring an intensive care unit, an operating room, an outpatient clinic, and a minor burns plastic surgery ward, admits approximately 120 patients and 80 minor burns annually. Adherence to mandatory hand hygiene and personal protective equipment protocols was monitored discretely via systematic observations by trained personnel. Non-compliance was graded on a binary scale.
Compliance data spanning January 2013 to August 2024 was culled from the hospital database. For analytical convenience, a composite measure of non-compliance across seven hygiene-related criteria was developed, with each instance of non-compliance scoring one point. This approach sought to present an overarching view of IPC performance and expedite trend detection in a high-compliance ambience.
The study adopted an interrupted time series analysis to estimate the impact of interventions on hygiene routine non-compliance. This analysis included two intervention periods in line with infection prevention control interventions during the A. baumannii outbreaks in 2014 and 2020.
This study reveals that monthly non-compliance, viewed as overall IPC performance, served as a valuable early warning system for increased outbreak risk. Hence, the use of such proactive preventive interventions, together with hand hygiene and adequate PPE usage, can significantly decrease the risk of multidrug-resistant infections in high-risk healthcare settings like burn ICU.
Source: https://aricjournal.biomedcentral.com/articles/10.1186/s13756-025-01592-9