Introduction: Over a 15 year period, our burn treatment center noted a pattern of AB resistance suspicious for a specific resistance clone and its’ variant. AB resistance was addressed via development of a multidisciplinary team to investigate and propose solutions to this problem.

Methods: An outside hospital epidemiologist consultant assessed infection control practices at an on-site visit of the burn treatment center and the intensive care units. The following recommendations were made: 1) establish AB control goals, 2) collect data on antibiotic use and AB isolation, 3) continue surveillance cultures, 4) redesign of the burn treatment center, and 5) redesign the hydrotherapy area. Immediate changes included: 1) contact isolation procedures according to the Centers for Disease Control, 2) cohorting AB patients, 3) individualization of all patient care equipment, 4) evaluation of cleaning solutions in use, and 5) if necessary total unit terminal cleaning.

Results: Comparison of multi-year cycles demonstrated a random process of “high” and “low” AB isolation (See graph below). The low yield of environmental and health care workers hand cultures did not correlate with AB recovery from patient cultures. Routine surveillance cultures of patient care areas sought out a potential nidus of AB. Surveillance cultures recovered multi resistant organisms with rare isolation of AB. Modification of behaviors and revision of cleaning practices improved environmental culture results.

Conclusion: Initiation of stringent hand washing and adherence to infection control guidelines eliminated both clones of AB. Chlorhexidine for handwashing is impaired by organic contaminates and may explain the low level persistence of AB in properly washed hands. Our successful approach and progressive control of the organism did not require closing of the burn unit. Although we never found the “one” source, we did identify and eliminate the sites that revealed positive cultures and modified likely processes that promoted contamination. Ultimately, we were successful in eliminating our resistant AB clones.