Control of a two-decade endemic situation with carbapenem-resistant Acinetobacter baumannii: electronic dissemination of a bundle of interventions.
BACKGROUND
Our institution continued to experience a hyperendemic situation with carbapenem-resistant Acinetobacter baumannii despite a bundle of interventions. We aim to describe the effect of the subsequent implementation of electronic dissemination of the weekly findings of a bundle of interventions.


METHODS
This was a quasiexperimental study performed at a 1,500-bed, public, teaching hospital. From January 2011 to March 2012, weekly electronic communications were sent to the hospital leadership and intensive care units (ICUs). These communications aimed to describe, interpret, and package the findings of the previous week's active surveillance cultures, environmental cultures, environmental disinfection, and hand cultures. Additionally, action plans based on these findings were shared with recipients.


RESULTS
During 42 months and 1,103,900 patient-days, we detected 438 new acquisitions of carbapenem-resistant A baumannii. Hospital wide, the rate of acquisition decreased from 5.13 ± 0.39 to 1.93 ± 0.23 per 10,000 patient-days, during the baseline and postintervention periods, respectively (P < .0001). This effect was also observed in the medical and trauma ICUs, with decreased rates from 67.15 ± 10.56 to 17.4 ± 4.6 (P < .0001) and from 55.9 ± 8.95 to 14.71 ± 4.45 (P = .0004), respectively.


CONCLUSIONS
Weekly and systematic dissemination of the findings of a bundle of interventions was successful in decreasing the rates of carbapenem-resistant A baumannii across a large public hospital.
Department of Medicine, University of Miami Miller School of Medicine, Miami, FL; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, FL; Jackson Health System, Miami, FL. Electronic address: smunozprice@med.miami.edu.
L Silvia
LS
Munoz-Price
Boston University, Boston, MA.
Philip
P
Carling
Department of Pathology, University of Miami Miller School of Medicine, Miami, FL.
Timothy
T
Cleary
Jackson Health System, Miami, FL.
Yovanit
Y
Fajardo-Aquino
Jackson Health System, Miami, FL.
Dennise
D
DePascale
Jackson Health System, Miami, FL.
Adriana
A
Jimenez
Jackson Health System, Miami, FL.
Michael
M
Hughes
Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, FL; Jackson Health System, Miami, FL; Department of Surgery, University of Miami Miller School of Medicine, Miami, FL.
Nicholas
N
Namias
Jackson Health System, Miami, FL; Department of Surgery, University of Miami Miller School of Medicine, Miami, FL.
Louis
L
Pizano
Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
Daniel H
DH
Kett
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; Division of Statistics, University of Miami Miller School of Medicine, Miami, FL.
Kristopher
K
Arheart
D000151:Acinetobacter Infections / Q000382:microbiology / Q000517:prevention & control*; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015780:Carbapenems / Q000494:pharmacology*; D004582:Electronics, Medical / Q000379:methods; D006784:Hospitals, Teaching; D006801:Humans; D017053:Infection Control / Q000379:methods*; D033181:Information Dissemination / Q000379:methods*; D064872:Patient Care Bundles / Q000379:methods*; D018440:beta-Lactam Resistance
D000900:Anti-Bacterial Agents; D015780:Carbapenems
Culture change; Hospital leadership; Management; Mass communication