title: Long-term control of hospital-wide, endemic multidrug-resistant Acinetobacter baumannii through a comprehensive "bundle" approach.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Sección Enfermedades Infecciosas, Hospital Universitario Virgen Macarena and Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Rodríguez-Baño
authors.forename: Lola
authors.initials: L
authors.lastname: García
authors.forename: Encarnación
authors.initials: E
authors.lastname: Ramírez
authors.forename: Luis
authors.initials: L
authors.lastname: Martínez-Martínez
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Muniain
authors.forename: Felipe
authors.initials: F
authors.lastname: Fernández-Cuenca
authors.forename: Margarita
authors.initials: M
authors.lastname: Beltrán
authors.forename: Juan
authors.initials: J
authors.lastname: Gálvez
authors.forename: Jose M
authors.initials: JM
authors.lastname: Rodríguez
authors.forename: Carmen
authors.initials: C
authors.lastname: Velasco
authors.forename: Concepción
authors.initials: C
authors.lastname: Morillo
authors.forename: Federico
authors.initials: F
authors.lastname: Perez
authors.forename: Andrea
authors.initials: A
authors.lastname: Endimiani
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bonomo
authors.forename: Alvaro
authors.initials: A
authors.lastname: Pascual
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D040981:Acinetobacter baumannii / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology; D015373:Bacterial Typing Techniques; D016000:Cluster Analysis; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D016172:DNA Fingerprinting; D024901:Drug Resistance, Multiple, Bacterial; D004493:Education; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006235:Hand Disinfection; D006302:Health Services Research; D006761:Hospitals; D006797:Housekeeping, Hospital; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055815:Young Adult