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Use of Adherence Monitors as Part of a Team Approach to Control Clonal Spread of Multidrug-Resistant Acinetobacter baumannii in a Research Hospital

  • Tara N. Palmore (a1), Angela V. Michelin (a1), MaryAnn Bordner (a1), Robin T. Odom (a1), Frida Stock (a1), Ninet Sinaii (a1), Daniel P. Fedorko (a1), Patrick R. Murray (a1) and David K. Henderson (a1)...



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.


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.


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.


Although labor intensive, adherence monitoring may be useful as part of a multifaceted strategy to limit nosocomial transmission of MDRAB.


Corresponding author

National Institutes of Health Clinical Center, National Institutes of Health, 10 Center Drive, MSC 1888, Bethesda, MD 20892 (


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1. Weber, DJ, Rutala, WA, Miller, MB, Huslage, K, Sickbert-Bennett, E. Role of hospital surfaces in the transmission of emerging health care-associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species. Am J Infect Control 2010;38:S25S33.
2. Munoz-Price, LS, Weinstein, RA. Acinetobacter infection. N Engl J Med 2008;358:12711281.
3. Chan, PC, Huang, LM, Lin, HC, et al. Control of an outbreak of pandrug-resistant Acinetobacter baumannii colonization and infection in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2007;28:423429.
4. Fournier, PE, Richet, H. The epidemiology and control of Acinetobacter baumannii in health care facilities. Clin Infect Dis 2006;42:692699.
5. Villegas, MV, Hartstein, AI. Acinetobacter outbreaks, 1977-2000. Infect Control Hosp Epidemiol 2003;24:284295.
6. Aygun, G, Demirkiran, O, Utku, T, et al. Environmental contamination during a carbapenem-resistant Acinetobacter baumannii outbreak in an intensive care unit. J Hosp Infect 2002;52:259262.
7. Harrington, SM, Stock, F, Kominski, AL, et al. Genotypic analysis of invasive Streptococcus pneumoniae from Mali, Africa, by semi-automated repetitive-element PCR and pulsed-field gel electrophoresis. J Clin Microbiol 2007;45:707714.
8. Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:22332239.
9. Choi, WS, Kim, SH, Jeon, EG, et al. Nosocomial outbreak of carbapenem-resistant Acinetobacter baumannii in intensive care units and successful outbreak control program. J Korean Med Sei 2010;25:9991004.
10. Dent, LL, Marshall, DR, Pratap, S, Hulette, RB. Multidrug resistant Acinetobacter baumannii: a descriptive study in a city hospital. BMC Infect Dis 2010;10:196.
11. La Forgia, C, Franke, J, Hacek, DM, Thomson, RB Jr, Robicsek, A, Peterson, LR. Management of a multidrug-resistant Acinetobacter baumannii outbreak in an intensive care unit using novel environmental disinfection: a 38-month report. Am J Infect Control 2010;38:259263.
12. Ling, ML, Ang, A, Wee, M, Wang, GC. A nosocomial outbreak of multiresistant Acinetobacter baumannii originating from an intensive care unit. Infect Control Hosp Epidemiol 2001;22:4849.
13. Manian, FA, Ponzillo, JJ. Compliance with routine use of gowns by healthcare workers (HCWs) and non-HCW visitors on entry into the rooms of patients under contact precautions. Infect Control Hosp Epidemiol 2007;28:337340.
14. Christie, C, Mazon, D, Hierholzer, W Jr, Patterson, JE. Molecular heterogeneity of Acinetobacter baumannii isolates during seasonal increase in prevalence. Infect Control Hosp Epidemiol 1995; 16:590594.
15. Perencevich, EN, McGregor, JC, Shardell, M, et al. Summer peaks in the incidences of gram-negative bacterial infection among hospitalized patients. Infect Control Hosp Epidemiol 2008;29: 1124-1131.
16. McDonald, LC, Banerjee, SN, Jarvis, WR. Seasonal variation of Acinetobacter infections: 1987-1996. Nosocomial Infections Surveillance System. Clin Infect Dis 1999;29:11331137.
17. Retailliau, HF, Hightower, AW, Dixon, RE, Allen, JR. Acinetobacter calcoaceticus: a nosocomial pathogen with an unusual seasonal pattern. J Infect Dis 1979;139:371375.
18. Barnaud, G, Zihoune, N, Ricard, JD, et al. Two sequential outbreaks caused by multidrug-resistant Acinetobacter baumannii isolates producing OXA-58 or OXA-72 oxacillinase in an intensive care unit in France. J Hosp Infect 2010;76:358360.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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