At Makassed Hospital’s open-bay intensive care unit (ICU), enhanced terminal disinfection (ETD) using hydrogen peroxide (H2O2) was performed without a predefined schedule in extensively-drug-resistant Acinetobacter baumannii (XDR-AB) outbreaks. In this study, we aimed to check for the value of the temporary closure of the ICU and the use of ETD with aerosolized H2O2 and Ag+ on minimizing the rate of XDR-AB acquisition in patients admitted to the ICU of our facility, which might consequently help us determine the optimal schedule for such procedure in this unit. This is a retrospective medical file review of patients admitted to the ICU between January 2016 and May 2018. We divided this period into numerical weeks (NW) after each closure and ETD episode. Risk factors of acquisition (RFA) were determined by comparing the characteristics of patients who acquired XDR-AB to those who didn’t. The proportion of patients residing in each NW was included in the RFA analysis. Out of 335 patients, 13% acquired XDR-AB. The overall incidence of XDR-AB acquisition was 14.6 cases/1000 patient days. RFA were XDR-AB contact pressure ≥ 3 days [Odds Ratio (OR) = 9.86, 95% Confidence Interval (CI) (3.65–26.64), P < 0.0001)], mechanical ventilation [OR = 4.99, 95%CI (1.76–14.15), P = 0.002)], and having a wound [OR = 3.72, 95%CI (0.99–13.96), P = 0.05)]. Patients who stayed during NW 7,11 and 14 were at risk of acquisition where the odds significantly increased by 6.5, 9.7 and 14.4 folds respectively (P = 0.03,0.01, and 0.01, respectively). We considered NW 7 as the most suitable time for temporary closure of the ICU and ETD with aerosolized H2O2. Contact pressure, mechanical ventilation, and presence of a wound were RFA of XDR-AB. Temporary closure of the ICU with ETD using aerosolized H2O2 decreased the rate of XDR-AB acquisition, yet this effect fades away with time. The ETD was shown to be most efficiently done when repeated every 7 calendar weeks in our open-bay ICU as part of a prevention bundle.

中文翻译：

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使用开放式隔间重症监护病房的雾化过氧化氢暂时关闭和增强终末消毒对获得广泛耐药性鲍曼不动杆菌的影响。

在望加锡医院的开放式加护病房（ICU）中，在没有广泛耐药性的鲍曼不动杆菌（XDR-AB）爆发中，没有预先确定的时间表使用过氧化氢（H2O2）进行了增强的终末消毒（ETD）。在这项研究中，我们旨在检查临时关闭ICU的价值以及将ETD与雾化的H2O2和Ag +一起使用的价值，以最大程度地减少入住我们设施ICU的患者的XDR-AB获得率。帮助我们确定此单元中此类程序的最佳时间表。这是对2016年1月至2018年5月期间入住ICU的患者的回顾性医学档案回顾。我们将该时间段划分为每次封堵和ETD发作后的数字周（NW）。通过比较获得XDR-AB的患者与未获得XDR-AB的患者的特征来确定获得性危险因素（RFA）。RFA分析中包括了每个NW中居住的患者比例。在335名患者中，有13％获得了XDR-AB。XDR-AB采集的总发生率为14.6例/ 1000患者日。RFA的XDR-AB接触压力≥3天[几率（OR）= 9.86，95％置信区间（CI）（3.65-26.64），P <0.0001）]，机械通气[OR = 4.99，95％CI（1.76） –14.15），P = 0.002）]，并且有伤口[OR = 3.72，95％CI（0.99-13.96），P = 0.05）]。在NW 7,11和14期间住院的患者有发生风险的几率分别显着增加6.5、9.7和14.4倍（分别为P = 0.03、0.01和0.01）。我们认为NW 7是使用雾化过氧化氢暂时关闭ICU和ETD的最合适时间。接触压力，机械通气和伤口的存在是XDR-AB的RFA。使用气雾化的H2O2暂时关闭ECU的ICU可以降低XDR-AB的获取率，但是这种影响会随着时间而逐渐消失。在我们的开放式ICU中，作为预防措施的一部分，每隔7个日历周重复进行一次ETD，结果证明其效率最高。