Effect of daily pillow cover replacement on the incidence of carbapenem resistant Acinetobacter baumannii (CRAB) in the medical intensive care units (MICU): a comparative study

Abstract Background Critically ill patients in intensive care units (ICUs) are at risk for colonization and infection by carbapenem-resistant Acinetobacter baumannii (CRAB), a multidrug-resistant pathogen with high mortality. Despite the use of infection control bundles, CRAB often persists on environmental surfaces, posing ongoing challenges for containment. The potential impact of managing soft environmental reservoirs—such as pillow covers—remains underexplored. This study evaluated whether daily pillow cover replacement can reduce CRAB acquisition in a medical ICU (MICU). Methods A prospective intervention study was conducted in a 23-bed MICU at a tertiary hospital in Korea between August 2023 and July, 2024. Standard infection prevention and control (IPC) practices, including hand hygiene, cohort isolation, chlorhexidine bathing, and routine cleaning, were consistent throughout the study. Starting February 1, 2024, pillow covers were replaced regularly as an additional intervention. CRAB acquisition was defined as positive clinical cultures obtained > 48 h after admission. Incidence rates were compared between the pre- and post-intervention periods using Poisson regression and interrupted time series analyses. Results A total of 152 patients met the inclusion criteria (108 pre- and 44 post-intervention). In this study, 224 CRAB-positive clinical specimens were identified from 152 patients, and only the first isolate per patient was included in the incidence analysis. The mean age was 76 years; 59.9% were male, and the average MICU stay was 26 days. Sputum accounted for 76.8% of CRAB-positive specimens. Compliance with daily pillow cover replacement was 100%. Poisson regression revealed a significant reduction in CRAB incidence following the intervention, with a 3.92% weekly decrease (95% CI 0.10–7.69%; p = 0.045). Conclusions When integrated into existing IPC bundles, daily pillow-cover replacement may reduce CRAB cross-transmission in the MICU. This simple, low-cost intervention with high compliance offers a promising strategy for improving environmental hygiene and infection control in high-risk settings.