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Table 6 General characteristics of the reported clusters and outbreaks in ICU

From: Multi-drug resistant Acinetobacter species: a seven-year experience from a tertiary care center in Lebanon

Timeline Characteristics Identified source Control measures Recurrence
1995–2007 Scattered clusters affecting 1–2 patients/month • Endogenous
• Common source
• Hand hygiene compliance
• Patient placement on contact isolation
Intermittent
2007–08 Outbreaks occurring in ICU on periodic basis Incidence rate 5–25/1000 patient-days Case-control study
• Endogenous
- Malignancy
- Recent surgery
• Common source
- Water contamination with MDR-Ab
• Targeted intervention
- Infection control practices
- Enforcing adherence to hand hygiene
- Proper use of personal protective equipment
- Controlled visitation to patients
- Targeted education and guidance
• Intensified presence of ICPP team
Frequent
2009–11 Major outbreaks occurring in ICU on monthly basis
Incidence rate 4–30/1000 patient-days
• Endogenous
- Underlying diseases
- Invasive procedures
• Common source
- Contaminated ventilators
Lack of compliance with IC measures
Key measures
• Strict compliance hand hygiene policy
• Patient placement on contact precautions until cleared by negative results of screening cultures
• Judicious use of antibiotics
• H2O2 decontamination
Ongoing
2012–14 Alternating endemic clusters and outbreaks occurring on monthly basis Colonization pressure: Significant findings for point and propagated sources Implementation of Drastic measures were implemented
- Key revisions of policies and procedures
- Key change in cleaning and disinfection methods
Ongoing
2012 2013 2014
284.0 263.0 322.0