ORIGINAL ARTICLES 599 19 2017 Background: The authors describe a multifaceted cross-infection control program that was implemented to contain an epidemic of multidrug-resistant microorganisms (MRO) (carbapenem resistant Pseudomonas aeruginosa and Acinetobacter bauma- nnii; extended spectrum β-lactamase producing Klebsiella pneumoniae, Escherichia coli , Enterobacter Cloacae, and Proteus mirabilis; and methicillin-resistant Staphylococcus aureus and Candida species). Objectives: To assess the effect of a control program on the incidence of cross-infection with MRO. Methods: Clinical criteria triaged patients into a high-risk wing (HRW) or a low-risk wing (LRW). Strict infection control measures were enforced; violations led to group discussions (not recorded). Frequent cultures were obtained, and use of antibiotics was limited. Each quarter, the incidence of MRO isolation was reported to all staff members. Results: Over a 6 year period, 1028 of 3113 patients were plac- ed in the HRW. The incidence of MRO isolation within 48 hours of admission was 8.7% (HRW) vs. 1.91% (LRW) (P < 0.001). Acquired MRO infection density was 30.4 (HRW) vs. 15.6 (LRW) (P < 0.009). After the second year, the incidence of group discus- sions dropped from once or twice a month to once or twice a year. Conclusions: These measures contained epidemics. Clinical criteria successfully triaged HRW from LRW patients and reduced cross-infection between the medical center wings. The quarterly reports of culture data were associated with improved staff compliance. MRO epidemic control with limited resources is feasible. IMAJ 2017; 19: 599–603 bacteriological surveillance, intensive care unit, multidrug- resistant microorganisms (MRO) triage, cross-infections Validation of a Cross-Infection Control Program in an Understaffed Intensive Care Unit Amit Frenkel MD MHA 1 , Abraham Borer MD 2 , Aviel Roy-Shapira MD 1,3 , Evgeni Brotfain MD 1 , Leonid Koyfman MD 1 , Lisa Saidel- Odes MD 2 , Alir Adina RN 1 and Moti Klein MD 1 1 Department of Anesthesiology and Critical Care, 2 Infection Control and Hospital Epidemiology Unit and 3 Department of Surgery Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel ABSTRACT: KEY WORDS: F ollowing a long-standing epidemic of cross-infection by multidrug-resistant microorganisms (MRO) in our multi- disciplinary intensive care unit, we instituted a comprehensive cross-infection control program, which eventually controlled the epidemics. Tis paper describes the measures taken and their efects. Epidemics of cross-infections by MRO can occur in any environment where broad spectrum antibiotics are ofen pre- scribed and frequent physical contact with the patients is ofen required [1-3]. However, in our case, the local epidemic spread over several years, and one or more MRO were isolated from virtually all patients who stayed in the unit for more than 5 days. At the time, the intensive care unit (ICU) was divided into two wings, each wing contained a hall with fve patient bays and a single bed isolation room. Te bays in the halls were separated by cloth curtains. We frst hypothesized that the cloth curtains separating each bed were the vector of cross-infection, and tried hanging newly washed and autoclaved curtains between admissions, but the epidemic continued. We next thought that cloth curtains were inadequate barriers and replaced them with vertical plaster of Paris and glass barriers. Again, the modifca- tions did not reduce the rate of cross-infection. Te administration planned to construct a new unit, better designed for patient isolation, to be housed in a new surgical complex, but at the time, the foundations of the complex were just laid, and the new facility was several years away (the new facility was completed in November 2013). In an attempt to reduce the rate of cross-infections in the interim, we implemented a comprehensive program that did not require staf increase or substantial structural changes. Te program was developed by a team of nurses, intensivists, and infectious disease specialists. It was not a research project, but rather an emergency measure to reduce MRO infection rates. Te protocol included prospectively planned periodic reviews, and we maintained bacteriological and epidemiological data. Te program successfully contained the epidemic. While some of the measures taken were particular to our unit, we think that many of the measures have universal applicability, and may be of interest to other units, particularly in areas with limited resources. PATIENTS AND METHODS SETTING At the time of program initiation, the ICU was a 12 adult bed closed unit, belonging to the main teaching hospital of Ben-