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Discussion

Straight Dope on Acinetobacter please

I had a patient with this last night, neither myself nor the RN I was with had ever heard of it. There was some question as to what type of isolation said pt should be in, so while we were waiting for the infection control nurse to get back w/us we googled this disease. It seems like quite the nasty (and rare) disease. The infection control nurse said that only standard precautions were necessary. But I have some reservations because:

1. several of the articles I read said "can survive in dry environments" (cdc.gov)

it 2. frequently lives in respiratory secretions

3. outbreak of this in the unit the pt came from (yes, maybe r/t handwashing, but I'm skeptical)

Any insight?

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  • Author

Bump

Anyone??

  • Admin
I had a patient with this last night, neither myself nor the RN I was with had ever heard of it. There was some question as to what type of isolation said pt should be in, so while we were waiting for the infection control nurse to get back w/us we googled this disease. It seems like quite the nasty (and rare) disease. The infection control nurse said that only standard precautions were necessary. But I have some reservations because:

1. several of the articles I read said "can survive in dry environments" (cdc.gov)

it 2. frequently lives in respiratory secretions

3. outbreak of this in the unit the pt came from (yes, maybe r/t handwashing, but I'm skeptical)

Any insight?

You can get info on this from:

CDC: Morbidity and Mortality Weekly Report, 2004 (November 19, 2004) Volume 53 (No. 45) : 1063-1066 at:

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5345a1.htm

U.S. Army Center for Health Promotion and Preventive Medicine (USACHPPM)

at:

http://chppm-www.apgea.army.mil

  • Author

Thank you much Madame!

I fear marshmallows sticking to the roof of my mouth, is that a disease too? :)

  • Admin
Thank you much Madame!

I fear marshmallows sticking to the roof of my mouth, is that a disease too? :)

You are welcome!! :)

Fear of marshmallows is: althaiophobia :D :balloons:

Our burn unit had an outbreak recently and all uninfected patients had to be moved to other units. After the infected pts. were treated and discharged, the burn unit got a complete overhaul as it was found in the ventilating system. After a prolonged "shut down "of that unit, it just reopened this week. Yikes!

  • Author

No kidding... Comforting to know that when they recycle machinery they are thoroughly cleaning it!!!

An update to my story; I recently was chatting with this Respiratory Therapist. We started talking and she told me that she normally works in the ICU & was floated over to my unit. I had to leave the room to go do something, and when I came back she was talking to the pt's family. Anyway, she was telling them how her SO had recently came back from Iraq. The CDC says that this disease is somehow linked to soldiers returning from Iraq... I was like WTH? I know its a bit of a stretch, but I went ahead & told my boss anyway.

  • Expert

Can't be said often enough: Wash your hands! Early and often, just like voting in Chicago. OK, that last part is a very old joke.

It's a gram - rod, and, like most gnrs, really loves a wet environment. Like humidifiers of any type--respiratory equipment!! I think, not too sure, that burn units use environmental humidification to help control fluid balance, so that would be another source. Some premies get body humidification for a while, too, for the same reason. The water that goes into these humidifying units should be sterile, and the units decontaminated/sterilized daily.

I'm sure it can live on dry surfaces, I know it likes dirt (as in soil), so when soil gets into a wound, like in an accident, Acinetobacter would be very happy in that wound, and wouldn't mind at all if someone gave it a rid to the pt next door's respiratory circuit. I don't think it wants to be dry for long, and I forget if it's a spore forming germ.

Keeping the overall environment clean is very helpful in diminishing the available germ load one is able to transfer to IVs, ETTs, wounds, etc. Even tho it's not a "nrsg" job, a quick wipe down of the overbed table, siderails, bedside cabinet would help prevent infections of all sorts, Acinetobacter included.

Whenever nurses are told to wash their hands, most go, "Yeah, yeah", and focus on some other thing they believe to be the culprit. I spent 7 years in Infection Control, and handwashing is the absolute cornerstone of the whole thing. Ask the family to wash, too, when they visit.

End of commercial. :rolleyes:

No kidding... Comforting to know that when they recycle machinery they are thoroughly cleaning it!!!

An update to my story; I recently was chatting with this Respiratory Therapist. We started talking and she told me that she normally works in the ICU & was floated over to my unit. I had to leave the room to go do something, and when I came back she was talking to the pt's family. Anyway, she was telling them how her SO had recently came back from Iraq. The CDC says that this disease is somehow linked to soldiers returning from Iraq... I was like WTH? I know its a bit of a stretch, but I went ahead & told my boss anyway.

i started seeing this prior to the invasion of iraq.

Acinetobacter...."ACE" is the name that our unit has given to Acinetobacter. My hospital is a trauma hospital...we have several cases of ACE that seem to get diagnosed in the trauma ICU. Once stable the patients are moved to either our Medical ICU, one particular step down unit, or one particular Med/Tele unit.

When the RN/CNA/RT are taking care of ACE patients....we don't go into any other patient rooms unless there is an emergency.

We must wear isolation gowns, gloves and masks in each room. The doorway of the room is the threshold that we cannot cross without the above PPE's. We have to do lots of education with patients, visitors, other staff from other units, transportors, etc. The doctors are almost the worst part of the whole system because they say, "I'm not going to touch anything." Then when we try to enforce the infection control department policies we almost have to become the "Isolation police."

Acinetobacter is a huge problem for a unit. once one patient in critical care has it, nearly every other patient does. Once the patient is discharged, we have to dispose of every consumable item in the room - syringes, etc all get sent to third world countries as acinetobacter live on for a long time and infect the room.

Huge problem, especially in our VAD patients!

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