title: Use of adherence monitors as part of a team approach to control clonal spread of multidrug-resistant Acinetobacter baumannii in a research hospital.
abstract: BACKGROUND
  Multidrug-resistant Acinetobacter baumannii (MDRAB) is difficult to treat and eradicate. Several reports describe isolation and environmental cleaning strategies that controlled hospital MDRAB outbreaks. Such interventions were insufficient to interrupt MDRAB transmission in 2 intensive care unit-based outbreaks in our hospital. We describe strategies that were associated with termination of MDRAB outbreaks at the National Institutes of Health Clinical Center.
  
  
  METHODS
  In response to MDRAB outbreaks in 2007 and 2009, we implemented multiple interventions, including stakeholder meetings, enhanced isolation precautions, active microbial surveillance, cohorting, and extensive environmental cleaning. We conducted a case-control study to analyze risk factors for acquiring MDRAB. In each outbreak, infection control adherence monitors were placed in MDRAB cohort areas to observe and correct staff infection control behavior.
  
  
  RESULTS
  Between May 2007 and December 2009, 63 patients acquired nosocomial MDRAB; 57 (90%) acquired 1 or more of 4 outbreak strains. Of 347 environmental cultures, only 2 grew outbreak strains of MDRAB from areas other than MDRAB patient rooms. Adherence monitors recorded 1,330 isolation room entries in 2007, of which 8% required interventions. In 2009, around-the-clock monitors recorded 4,892 staff observations, including 127 (2.6%) instances of nonadherence with precautions, requiring 68 interventions (1.4%). Physicians were responsible for more violations than other staff (58% of hand hygiene violations and 37% of violations relating to gown and glove use). Each outbreak terminated in temporal association with initiation of adherence monitoring.
  
  
  CONCLUSIONS
  Although labor intensive, adherence monitoring may be useful as part of a multifaceted strategy to limit nosocomial transmission of MDRAB.
authors.affiliation: Clinical Center, National Institutes of Health, Bethesda, Maryland 20892, USA. tpalmore@mail.nih.gov
authors.forename: Tara N
authors.initials: TN
authors.lastname: Palmore
authors.forename: Angela V
authors.initials: AV
authors.lastname: Michelin
authors.forename: Maryann
authors.initials: M
authors.lastname: Bordner
authors.forename: Robin T
authors.initials: RT
authors.lastname: Odom
authors.forename: Frida
authors.initials: F
authors.lastname: Stock
authors.forename: Ninet
authors.initials: N
authors.lastname: Sinaii
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Fedorko
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Murray
authors.forename: David K
authors.initials: DK
authors.lastname: Henderson
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control*; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000302:isolation & purification; D016022:Case-Control Studies; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D004196:Disease Outbreaks / Q000517:prevention & control; D024901:Drug Resistance, Multiple, Bacterial; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D016015:Logistic Models; D008396:Maryland / Q000453:epidemiology; D009316:National Institutes of Health (U.S.); D009726:Nurses; D011481:Protective Clothing / Q000706:statistics & numerical data; D012307:Risk Factors; D018571:Sentinel Surveillance; D014481:United States / Q000453:epidemiology
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