title: A multifaceted intervention to reduce pandrug-resistant Acinetobacter baumannii colonization and infection in 3 intensive care units in a Thai tertiary care center: a 3-year study.
abstract: BACKGROUND
  We sought to determine the long-term effect of a multifaceted infection-control intervention to reduce the incidence of pandrug-resistant Acinetobacter baumannii infection in a Thai tertiary care center.
  
  
  METHODS
  A 3-year, prospective, controlled, quasi-experimental study was conducted in medical intensive care, surgical intensive care, and coronary care units for a 1-year period before intervention (period 1), a 1-year period after intervention (period 2), and a 1-year follow-up period (period 3). The interventions in period 2 included strictly implementing contact isolation precautions and appropriate hand hygiene, active surveillance, cohorting patients who were colonized or infected with pandrug-resistant A. baumannii, and environmental cleaning with 1:100 sodium hypochlorite solution. All interventions were continued in period 3, but environmental cleaning solutions were changed to detergent and phenolic agents.
  
  
  RESULTS
  Before the intervention, the rate of pandrug-resistant A. baumannii colonization and/or infection was 3.6 cases per 1000 patient-days. After the intervention, the rate of pandrug-resistant A. baumannii colonization and/or infection decreased by 66% in period 2 (to 1.2 cases per 1000 patient-days; P < .001) and by 76% in period 3 (to 0.85 cases per 1000 patient-days; P < .001). The monthly hospital antibiotic cost of treating pandrug-resistant A. baumannii colonization and/or infection and the hospitalization cost for each patient in the intervention units were also reduced by 36%-42% (P < .001) and 25%-36% (P < .001), respectively, during periods 2 and 3.
  
  
  CONCLUSIONS
  A multifaceted intervention featuring active surveillance and environmental cleaning resulted in sustained reductions in the rate of pandrug-resistant A. baumannii colonization and infection, the cost of antibiotic therapy, and the cost of hospitalization among intensive care unit patients in a developing country.
authors.affiliation: Division of Infectious Diseases and Infection Control, Thammasat University Hospital, Pratumthani, Thailand. anapisarn@yahoo.com
authors.forename: Anucha
authors.initials: A
authors.lastname: Apisarnthanarak
authors.forename: Uayporn
authors.initials: U
authors.lastname: Pinitchai
authors.forename: Kanokporn
authors.initials: K
authors.lastname: Thongphubeth
authors.forename: Chananart
authors.initials: C
authors.lastname: Yuekyen
authors.forename: David K
authors.initials: DK
authors.lastname: Warren
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy / Q000517:prevention & control*; D040981:Acinetobacter baumannii / Q000187:drug effects*; D003428:Cross Infection / Q000517:prevention & control*; D024901:Drug Resistance, Multiple, Bacterial; D006746:Hospital Bed Capacity, 500 and over; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control; D007362:Intensive Care Units; D013785:Thailand