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

• Published in: American journal of infection control 2009-11, Vol.37 (9), p.715-722
• Main Authors: Rodríguez-Baño, Jesús, MD, PhD, García, Lola, RN, Ramírez, Encarnación, MD, PhD, Martínez-Martínez, Luis, MD, PhD, Muniain, Miguel A., MD, PhD, Fernández-Cuenca, Felipe, MD, PhD, Beltrán, Margarita, PhD, Gálvez, Juan, MD, Rodríguez, Jose M., PhD, Velasco, Carmen, PhD, Morillo, Concepción, RN, Perez, Federico, MD, Endimiani, Andrea, MD, PhD, Bonomo, Robert A., MD, Pascual, Alvaro, MD, PhD
• Format: Article
• Language: English
• Subjects: Acinetobacter baumannii - classification; Acinetobacter baumannii - drug effects; Acinetobacter baumannii - genetics; Acinetobacter baumannii - isolation & purification; Acinetobacter Infections - epidemiology; Acinetobacter Infections - microbiology; Acinetobacter Infections - prevention & control; Adolescent; Adult; Aged; Aged, 80 and over; Bacteremia - microbiology; Bacterial Typing Techniques; Cluster Analysis; Cross Infection - epidemiology; Cross Infection - microbiology; Cross Infection - prevention & control; Disease prevention; Disease transmission; DNA Fingerprinting; Drug resistance; Drug Resistance, Multiple, Bacterial; Education; Electrophoresis, Gel, Pulsed-Field; Female; Genotype; Gram-negative bacteria; Hand Disinfection; Health Services Research; Hospitals; Housekeeping, Hospital; Humans; Infection Control; Infection Control - methods; Infectious Disease; Male; Middle Aged; Nosocomial infections; Young Adult
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2009.01.008

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.