Long-term control of hospital-wide, endemic multidrug-resistant Acinetobacter baumannii through a comprehensive bundle'' approach

Background: Acinetobacter baumannii (Ab) is emerging as a multidrug-resistant (MDR) nosocomial pathogen of considerable clinical importance. Data on the efficacy of infection control measures in endemic situations are lacking. Here, we investigated the impact of a long-term multifaceted bundle'' approach in controlling endemic MDR Ab in a 950-bed tertiary care center. Methods: Ongoing staff education, promotion of hand hygiene, strict Contact and Isolation Precautions, environmental cleaning, and targeted active surveillance in high-risk areas during periods of likely transmission and contamination were initiated in this program. To assess the efficacy of our interventions, we recorded (before and after the intervention) the epidemiologic and clinical features of MDR Ab infections and determined the clonal relationship among MDR Ab bloodstream isolates by pulsed-field gel electrophoresis. Results: Before the bundle'' was instituted, the rate of colonization/infection was 0.82 cases per 100 admissions (1994-1995). Colonization/infection rates showed a sustained decrease after implementation of the control program in 1995 to 0.46 in 1996-1997 and to 0.21 in 1998-2003 (P < .001). Coincident with the institution of this program, the rate of bacteremia because of MDR Ab decreased 6-fold during the 8-year observation period. A notable change in the clonal distribution of the MDR Ab isolates was also demonstrated. Conclusion: The implementation of a comprehensive and multifaceted infection control program (bundle'') in a tertiary care center effectively controlled the spread and clinical impact of MDR Ab. Copyright (C) 2009 by the Association for Professionals in Infection Control and Epidemiology, Inc. (Am J Infect Control 2009; 37: 715-22.)