1. CRE prevalence among patients with no prior history of carriage
The impact of a national coordinated intervention on control of carbapenem-resistant Enterobacteriaceae in post-acute care hospitals (PACH) in Israel
Debby Ben-David, Samira Masarwa, Ester Solter, David Schwartz, Amos Adler, Yehuda Carmeli, Mitchell J. Schwaber
National Center for infection control , Ministry of Health, Israel
Background
Since 2006, the Israeli healthcare system has confronted
nationwide spread of CRE. In 2008, high carriage
prevalence was detected in PACH. Consequently, a
multifaceted intervention was initiated in PACH, as part
of a centralized program involving all healthcare
institutions nationwide
Methods
Setting
15 PACH with a total of 3550 beds.
Ward types: skilled nursing care, chronic mechanically
ventilated, sub-acute medical and rehabilitation.
Intervention
1) Improving practice of general infection control, hand
hygiene, standard precautions and environmental
cleaning
2) Intensified CRE containment measures
national CRE network
- daily coordination of inter-facility transfers and
acquisitions
- central management of local outbreaks
admission rectal screening
population-tailored contact precautions
3) Site visits
use of a 16-point score to assess infection control
practices and implementation of a CRE control program
4) Five cross-sectional prevalence surveys
rectal CRE screening was performed on all patients in
representative wards
. Outcome
Prevalence of CRE among screened patients with
unknown history of CRE carriage
Results
Infection control measures were assessed during 58 visits
Cross sectional surveys
A total of 6785 patients were screened, among whom 84% had no prior
history of CRE carriage. Newly-detected carriage rates were higher in
wards with a higher prevalence of known carriers and no CRE screening
on admission (Graph 1) Table 2 and Graph 2 summarized the results of
5 surveys
TABLE 1: Infection control measures
2008
2009
2011
2013
2015
Average infection control score (0-16)
6.9
11.5
13.7
14.9
15.3
CRE admission screening 7%
75%
90%
98%
100%
Alcohol rub availability at point of care
14%
50%
73%
96%
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TABLE 2: Comparison between 5 surveys of CRE carriage
prevalence
2008
2009
2011
2013
2015 P
Number of wards 27 28 37 43 35 --
Total number of patients
1148
1209
1390
1534
1589
Prevalence of known
CRE carriers (%)
12%
15%
20%
19%
14%
0.48
CRE carrier influx (n)
514
437
601
564
448
0.33
Total CRE prevalence of the survey date (known and newly detected) (%)
16.9
13.7
13.9
8.0
3.3
P>.001
CRE prevalence among patients with no prior history of carriage
12.3
9.1
9.2
3.9
0.8
P<.001 .
Conclusion
A national multifaceted intervention resulted
in a sustained decrease in CRE acquisitions
among patients hospitalized in PACH
Key elements of the intervention:
establishment of a centrally coordinated
containment program
early detection of carriers
tailored contact precautions