AN OUTBREAK INVESTIGATION AND CONTROL OF MDR KLEBSIELLA PNEUMONIAE IN SURGICAL INTENSIVE CARE UNIT IN A TERTIARY CARE HOSPITAL.

*Dr. Udayasri B., Dr. Rama Devi V. and Dr. Srinivas N.

ABSTRACT

Aim and objective: To identify the source of out break caused by MDR Klebsiella pneumoniae in a Surgical intensive care unit. To define the control measures to eliminate the source and prevent further out breaks. Materials and methods: A study was conducted to investigate an outbreak caused by MDR Klebsiella pneumoniae in SICU-I at Krishna institute of Medical sciences, Secunderabad. In the First week of June, 3 patients in SICU-I developed Ventilator associated pneumonia with MDR Klebsiella pneumoniae. Taking it into consideration HIC department became alert and conducted a preliminary review of Patients characteristics and microbiology reports in all those whose specimen was positive for Klebsiella pneumoniae for the month May and June. A total number of 9 patients were infected with same strain of Klebsiella pneumoniae tracing back to first case which was detected on 2-5-2018. The strain was identified by AST and other phenotypic methods using VITEK 2 Compact system. In response to above finding environmental samples were collected from various sites in SICU, out of them swabs collected from few suction jars yielded growth of same strain of Klebsiella pneumoniae. SICU was evacuated and patients were shifted to other ICU, followed by thorough cleaning, deep scrubbing and disinfection of all surfaces was done. All the suction jars and their wall units were thoroughly washed, disinfected and sent for sterilization. Fogging was done according to standard protocol. Microbiological surveillance of surfaces and air was done and found to be satisfactory. A new protocol for changing suction jars was formed and implemented stating that daily suction jars should be cleaned and disinfected with bacillocid 1% solution then sent for ETO sterilization. An additional protocol was formed regarding change of Oral suction yunkar tubes 8 hourly to reduce colonization. Results: For next one month follow-up was done in patients admitted to SICU by microbiological analysis to detect colonization with MDR Klebsiella pneumoniae. Microbiological analysis was done for the suction units by randomly collecting swabs to detect environmental colonization. The culture were found to be negative and satisfactory. Conclusion: The out break ended after implementation of the new protocol for sterilization of suction jars and additional precaution with frequent changing of Oral suction Yunkars.

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