Control of a two-decade endemic situation with carbapenem-resistant Acinetobacter baumannii: Electronic dissemination of a bundle of interventions

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• 作者：L. Silvia Munoz-Price ; MD^a ; ^b ; ^c ; ^d ; ^{smunozprice@med.miami.edu" class="auth_mail} ; Philip Carling ; MD^e ; Timothy Cleary ; PhD^f ; Yovanit Fajardo-Aquino ; MD^d ; Dennise DePascale ; MT^d ; Adriana Jimenez ; MT^d ; Michael Hughes^d ; Nicholas Namias ; MD^c ; ^d ; ^g ; Louis Pizano ; MD^d ; ^g ; Daniel H. Kett ; MD^a ; Kristopher Arheart ; EdD^b ; ^h
• 关键词：Culture change ; Management ; Mass communication ; Hospital leadership
• 刊名：American Journal of Infection Control
• 出版年：May 2014
• 年：2014
• 卷：42
• 期：5
• 页码：466-471
• 全文大小：790 K

文摘

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.

Conclusion

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.