title: Long-term effectiveness of infection and antibiotic control programs on the transmission of carbapenem-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii complex in central Taiwan.
abstract: OBJECTIVE
  A carbapenem-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii complex (CRA complex) infection is one of most the difficult infections to control worldwide. We evaluated the long-term effects of infection control interventions on the incidence densities of healthcare-associated infection (HAI) and CRA complex infection, and the rates of Acinetobacter calcoaceticus-Acinetobacter baumannii complex bacteremia (AB).
  
  
  METHODS
  We performed a cross-sectional analysis at the Changhua Christian Hospital from January 2002 to December 2013. Interventions for infection control were implemented from 2002 to 2009 (period 1). From 2010 to 2013 (period 2), infection control programs were improved by in-service education and a hand hygiene campaign to prepare for international and national hospital accreditation. The effectiveness of infection and antibiotic control programs was assessed according to the incidence densities of HAI and CRA complex, rates of CRA complex and of AB, chlorhexidine consumption density, and defined daily dose of antibiotics.
  
  
  RESULTS
  The incidence density of HAI decreased from 4.56‰ to 1.52‰ from periods 1 to 2 (P<0.001). Likewise, the incidence of AB decreased from 177.79 to 137.76 per person-years per 100,000 admissions (P<0.001). The incidence density of CRA complex ranged from 3.17-7.38‰. The chlorhexidine consumption density increased from 5.5 to 45.5 L per 1000 patient-days (P<0.001). The consumption of piperacillin-tazobactam was lower in period 2 than in period 1 (P<0.001).
  
  
  CONCLUSIONS
  Education for infection control programs, hand hygiene campaigns, and antibiotics control programs may decrease the incidence density of AB and HAI, and may help control CRA complex infection.
authors.affiliation: Infection Control Committee, Changhua Christian Hospital, 135 Nan-hsiao Street, Changhua, Taiwan, ROC; Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, 135, Nan-hsiao Street, Changhua, Taiwan, ROC; Department of Nursing, College of Medicine & Nursing, Hung Kuang University, No. 1018,Sec. 6, Taiwan Boulevard, Sha-lu District, Taichung 43302, Taiwan, ROC. Electronic address: 76590@cch.org.tw.
authors.forename: C-H
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Infection Control Committee, Changhua Christian Hospital, 135 Nan-hsiao Street, Changhua, Taiwan, ROC.
authors.forename: L-C
authors.initials: LC
authors.lastname: Lin
authors.affiliation: Epidemiology and Biostatics Center, Changhua Christian Hospital, 135 Nan-hsiao Street, Changhua, Taiwan, ROC.
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Chang
authors.affiliation: Infection Control Committee, Changhua Christian Hospital, 135 Nan-hsiao Street, Changhua, Taiwan, ROC; Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, 135, Nan-hsiao Street, Changhua, Taiwan, ROC.
authors.forename: C-E
authors.initials: CE
authors.lastname: Liu
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, Changhua Christian Hospital, 135, Nan-hsiao Street, Changhua, 500, Taiwan, ROC.
authors.forename: M-S
authors.initials: MS
authors.lastname: Soon
mesh_terms: D000151:Acinetobacter Infections / Q000517:prevention & control* / Q000635:transmission*; D040981:Acinetobacter baumannii; D016954:Acinetobacter calcoaceticus; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use*; D002648:Child; D003428:Cross Infection / Q000517:prevention & control* / Q000635:transmission*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
keywords: Acinetobacter baumannii-Acinetobacter calcoaceticus; Acinetobacter calcoaceticus-Acinetobacter baumannii; Antibiotic stewardship; Bon usage des antibiotiques; Carbapenem-resistance; Hand hygiene; Hygiène des mains; Infection control; Résistance aux carbapénèmes