Acinetobacter – the trojan horse of infection control?

L. Teare*, N. Martin, W. Elamin, K. Pilgrim, T. Tredoux, J. Swanson, Peter Hoffman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Background: Five cases of multi-resistant Acinetobacter baumanii (MRA) producing OXA-23 and OXA-51 occurred in a regional burn intensive care unit (BICU). Three were repatriated from other parts of the world (Dubai and Mumbai) and colonized on admission. Despite optimal precautions, two patients acquired MRA. Both had been nursed in the same room. Methods: Multi-disciplinary outbreak investigation of MRA in a regional BICU. Findings: The mechanism of transfer for the first case is thought to have been contaminated air from theatre activity releasing MRA bacteria into the communal corridor. No MRA patients went to theatre between the first and second acquired cases. The mechanism of transfer for the second case is thought to have been via a shower unit that was decontaminated inadequately between patients. Conclusion: In an outbreak where contact precautions and environmental cleaning are optimal, it is important to give careful consideration to other mechanisms of spread. If there is a failure to do this, it is likely that the true causes of transmission will not be addressed and the problem will recur. It is recommended that burn theatres within burn facilities should be designed to operate at negative pressure; this is the opposite of normal operating theatre ventilation. Where showers are used, both the shower head and the hose should be changed after a patient with a resistant organism. The role of non-contact disinfection (e.g. hydrogen peroxide dispersal) should be reconsidered, and constant vigilance should be given to any ‘trojan horse’ item in the room.

Original languageEnglish
Pages (from-to)45-53
Number of pages9
JournalJournal of Hospital Infection
Issue number1
Publication statusPublished - May 2019

Bibliographical note

Funding Information:
The authors would like to thank the staff in the Antimicrobial Resistance and Healthcare Associated Infection Reference Unit, National Infection Service, Public Health England, London for typing and antimicrobial susceptibility investigations. The authors are also grateful to the staff of St Andrew's Burn Service for their commitment to the highest standards of patient care during this outbreak episode.

Publisher Copyright:
© 2018

Copyright 2019 Elsevier B.V., All rights reserved.


  • Acinetobacter baumanii
  • Burns
  • Fogging
  • Hosepipe
  • International transfer aromatherapy
  • Misting
  • Multi-resistant bacteria
  • Shower


Dive into the research topics of 'Acinetobacter – the trojan horse of infection control?'. Together they form a unique fingerprint.

Cite this