Transmission of carbapenem-resistant Acinetobacter baumannii (CRAB) can be facilitated by lapses in infection prevention and control practices among healthcare workers, underscoring the need for proactive, real-time surveillance. In November 2025, a CRAB outbreak occurred at a cardiac tertiary care center in Karachi, Pakistan, involving seven patients who developed central line-associated bloodstream infections and hospital-acquired pneumonia. Following an Infection Control Committee meeting, a one-month intensive surveillance program was implemented from December 1–31, 2025, deploying a senior infection control nurse exclusively during evening shifts to observe, document, and provide immediate corrective teaching across all clinical areas, including intensive care, coronary care, operating rooms, and dialysis units. Over four weeks, 309 spot teaching sessions were conducted with 64, 85, 73, and 87 healthcare workers, respectively. Persistent systemic non-compliance was identified across multiple domains, including incorrect use of personal protective equipment, particularly in operating rooms and during isolation precautions; improper disposal of sharps and biomedical waste; delayed initiation of isolation; critical reprocessing failures involving bougie catheters and oxygen bottles; and environmental hygiene deficits, including rusted equipment. The surveillance uncovered a critical lack of standardization in bougie catheter classification across units and hazardous pre-transport practices, including sending contaminated items to central sterile processing. Following real-time corrective interventions and escalation of systemic issues to management, the outbreak was successfully contained with no new CRAB cases reported during or after the surveillance period. This experience demonstrates that targeted, proactive infection-prevention surveillance during high-risk evening shifts, combined with immediate educational reinforcement, can effectively identify and address latent systemic failures and behavioral non-compliance that might be overlooked during routine daytime audits, thereby providing a practical framework for outbreak mitigation in resource-constrained settings.