Environmental sources apart from air need to be investigated first.

e480 www.ccmjournal.org December 2013 • Volume 41 • Number 12 The authors reply: We thank Chao et al (1) for their comments about our work (2). We fully agree with their primary statement that investigation of air contamination with Acinetobacter baumannii should not be performed until the degree of environmental contamination (e.g., bedrails and bedside tables) within the inpatient areas is fully addressed. At our hospital, we have had an endemic situation with carbapenemresistant A. baumannii for almost two decades (3). Even though this was a polyclonal process, the predominant clone (ST79) remained in circulation for 6 years (3). A bundle of interventions was implemented throughout the years in order to contain new acquisitions with A. baumannii (L.S. Munoz-Price, unpublished data, 2013). The bundle consisted of interventions that targeted different pathways of transmission, including contaminated healthcare worker hands by using hand hygiene interventions that included hand cultures (4), contaminated environment, and shared objects (Fig. 1). This is similar to other bundle of interventions implemented for the containment of carbapenem-resistant Enterobacteriaceae (5). In regard to the hospital environment, we performed serial cultures of surfaces across inpatients’ rooms, especially among our ICUs (6). Given the degree of contamination we found, an improvement process of surface disinfection was done using ultraviolet markers (7–9). Currently, we are evaluating the impact of inadvertent exposure to contaminated surfaces with A. baumannii on the later acquisition of this pathogen (L.S. Munoz-Price, unpublished data, 2013). In summary, the investigation of air as a vehicle for the transmission of A. baumannii is only part of our multipronged approach for the containment of this organism. Dr. Doi received grant support from Merck. The remaining authors have disclosed that they do not have any potential conflicts of interest.