Association of private isolation rooms with ventilator-associated Acinetobacter baumanii pneumonia in a surgical intensive-care unit.

OBJECTIVE: To determine the rates and routes of Acinetobacter baumanii colonization and pneumonia among ventilated patients in a surgical intensive-care unit (SICU) before and after architectural modifications. DESIGN: A nonsequential study comparing two groups of patients. All isolates from systematic and clinical samples were genotyped by pulsed-field gel electrophoresis (PFGE). Records of patients hospitalized during the first and second periods were reviewed and findings were compared. Between the two periods, the SICU was remodeled from enclosed isolation rooms and open rooms to only enclosed isolation rooms with handwashing facilities in each room. SETTING AND PATIENTS: All patients hospitalized and mechanically ventilated for more than 48 hours in the 15bed SICU of the University Hospital of Besancon (France). RESULTS: For the first and second periods, the rates of colonization were, respectively, 28.1% and 5.0% of patients (P<10-7; relative risk [RR], 2.23; 95% confidence interval [CI95], 1.8-2.75) and the specific rates of bronchopulmonary (BP) colonization were, respectively, 9.1 and 0.5 per 1,000 days of mechanical ventilation (P<10-5). Seven major PFGE isolate types were identified, 4 of which were isolated from 44 of the 47 colonized or infected patients. Logistic regression analysis showed that colonization was not associated with patient characteristics. CONCLUSION: Conversion from open rooms to isolation rooms may help control nosocomial BP tract acquisition of A baumanii in mechanically ventilated patients hospitalized in an SICU (Infect Control Hosp Epidemiol 1997;18:499-503). During the last decade, Acinetobacter baumanii and Acinetobacter genospecies 3 have emerged as important hospital pathogens.1 Although most clinical isolates represent colonization rather than infection, Acinetobacter is now one of the most common nosocomial pathogens in respiratory tract infections in the intensive-care units (ICUs) .2'3 The present study was conducted to assess the rate and routes of ventilator-associated A baumanii colonization and pneumonia, because this organism was responsible for high endemic rates in the studied surgical intensive-care unit (SICU). Coincidental architectural modification midway through the study, converting all patient areas to single rooms with handwashing facilities in each room, provided a unique opportunity to examine prospectively the relation between the design of an intensive-care unit and nosocomial colonization and infection with this organism.