Brief Report Getting to zero: Reduction in the incidence of multidrug-resistant organism infections using an integrated infection control protocol in an intensive care unit Rohit Gupta MD a , Emily Hannon a , Shirish Huprikar MD b , Adel Bassily-Marcus MD a , Anthony Manasia MD a , John Oropello MD a , Roopa Kohli-Seth MD a, * a Department of Surgery, Division of Critical Care, Icahn School of Medicine at Mount Sinai, New York, NY b Department of Medicine, Division of Infectious Disease, Icahn School of Medicine at Mount Sinai, New York, NY Key Words: Environmental cleaning Burkholderia cepacia complex ATP testing Environmental cleaning is a vital component of infection control. We describe the use of an integrated infection control protocol in an intensive care unit and its influence on multidrug-resistant organism in- fection rates. Sustained reductions in multidrug-resistant organism infections can be achieved if individual processes and weaknesses in intensive care unit environments are identified and addressed in a system- atic and comprehensive manner. © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. INTRODUCTION Multidrug-resistant organisms (MDROs) are the leading cause of hospital-acquired infections in intensive care units (ICUs). 1 These organisms include a range of gram-positive and gram-negative bac- teria that are resistant to 1 or more class of antibiotics. 2 MDROs cause infections that are more difficult to treat, persist longer, and have higher mortality and associated health care costs. 3,4 Despite various measures, including hand hygiene, personal pro- tective equipment, and universal precaution measures, MDRO infection rates continue to remain high. Prompted by an outbreak of Burkholderia cepacia complex (BCC) in our ICU, we implemented an integrated infection control proto- col to address the multiple links in the environmental transmission of infections. Here we describe the influence of our protocol on MDRO infection rates in our ICU over a 12-month period. METHODS Our surgical ICU (SICU) is a 14-bed unit within our 1,170 bed ter- tiary care hospital that manages a spectrum of complex medical and surgical patients. For the first 5 months of the year, 6% of the admissions (15 cases) to the SICU were noted to be colonized or infected with BCC. In response, a quality improvement committee that included intensivists, environmental services representatives, and infec- tious disease specialists was convened to design and implement an infection control protocol. Before implementation of our new protocol, patient rooms were routinely cleaned with alcohol-based preparations for disinfec- tion of small surfaces and with bleach compounds for larger surfaces. Room sanitation was managed by the hospital EVS with little in- teraction or input from the other ICU services. As part of the infection control protocol, all SICU patients were transferred out and the unit was closed down for a 2-day compre- hensive cleaning. All patient rooms and the staff stations were cleaned with hypochlorite solutions and ultraviolet (UV) C radia- tion. Patient care items were disposed of and all existing ventilators were replaced. Subsequent to the reopening of the unit, several mea- sures were introduced. Daily high-touch point cleaning protocol A systematic cleaning protocol was implemented that focused on regular, thorough bleach cleaning of high-touch points on a daily basis. These high-touch points were specified areas in patient rooms that were more frequently exposed to human contact and thus more likely to get contaminated. Disposable microfiber cloths were used to prevent cross-infection of rooms. * Address correspondence to Roopa Kohli-Seth, MD, Icahn School of Medicine, One Gustave L Levy Place, Box 1264, New York, NY 10029. E-mail address: roopa.kohli-seth@mountsinai.org (R. Kohli-Seth). Conflicts of interest: None to report. ARTICLE IN PRESS 0196-6553/© 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2016.07.003 American Journal of Infection Control ■■ (2016) ■■-■■ Contents lists available at ScienceDirect American Journal of Infection Control journal homepage: www.ajicjournal.org American Journal of Infection Control