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Institutional Control Measures to Curtail the Epidemic Spread of Carbapenem-Resistant Klebsiella pneumoniae: A 4-Year Perspective

  • Matan J. Cohen (a1), Colin Block (a2), Phillip D. Levin (a3), Carmela Schwartz (a2), Ilana Gross (a2), Yuval Weiss (a4), Allon E. Moses (a2) and Shmuel Benenson (a2)...
Objective.</title><p>To describe the implementation of an institution-wide, multiple-step intervention to curtail the epidemic spread of carbapenem-resistant <span class='italic'>Klebsiella pneumoniae</span> (CRKP).</p></sec><sec id='abs2'><title>Design.</title><p>Consecutive intervention analyses.</p></sec><sec id='abs3'><title>Patients and Setting.</title><p>All patients admitted to a 775-bed tertiary care medical center in Jerusalem, Israel, from 2006 through 2010.</p></sec><sec id='abs4'><title>Interventions.</title><p>The effects of 4 interventions were assessed: (1) a policy of isolation for patients colonized or infected with CRKP in single rooms, which was started in March 2006; (2) cohorting of CRKP patients with dedicated nursing staff and screening of patients neighboring a patient newly identified as a carrier of CRKP, which was started in March 2007; (3) weekly active surveillance of intensive care unit patients, which was started during August 2008; and (4) selective surveillance of patients admitted to the emergency department, which was started in March 2009. Interrupted regression analysis and change-point analysis were used to assess the effect of each intervention on the CRKP epidemic.</p></sec><sec id='abs5'><title>Results.</title><p>Patient isolation alone failed to control the spread of CRKP, with incidence increasing to a peak of 30 new cases per 1,000 hospital beds per month. Institution of patient cohorting led to a steep decline in the incidence of CRKP acquisition (<span class='italic'>P</span>&lt; .001). Introduction of active surveillance interventions was followed by a decrease in the incidence of CRKP-positive clinical cultures but an increase in the incidence of CRKP-positive screening cultures. The mean prevalence of CRKP positivity for the period after cohorting began showed a statistically significant change from the mean prevalence in the preceding period (<span class='italic'>P</span>&lt; .001).</p></sec><sec id='abs6'><title>Conclusions.
Objective.

To describe the implementation of an institution-wide, multiple-step intervention to curtail the epidemic spread of carbapenem-resistant Klebsiella pneumoniae (CRKP).

Design.

Consecutive intervention analyses.

Patients and Setting.

All patients admitted to a 775-bed tertiary care medical center in Jerusalem, Israel, from 2006 through 2010.

Interventions.

The effects of 4 interventions were assessed: (1) a policy of isolation for patients colonized or infected with CRKP in single rooms, which was started in March 2006; (2) cohorting of CRKP patients with dedicated nursing staff and screening of patients neighboring a patient newly identified as a carrier of CRKP, which was started in March 2007; (3) weekly active surveillance of intensive care unit patients, which was started during August 2008; and (4) selective surveillance of patients admitted to the emergency department, which was started in March 2009. Interrupted regression analysis and change-point analysis were used to assess the effect of each intervention on the CRKP epidemic.

Results.

Patient isolation alone failed to control the spread of CRKP, with incidence increasing to a peak of 30 new cases per 1,000 hospital beds per month. Institution of patient cohorting led to a steep decline in the incidence of CRKP acquisition (P< .001). Introduction of active surveillance interventions was followed by a decrease in the incidence of CRKP-positive clinical cultures but an increase in the incidence of CRKP-positive screening cultures. The mean prevalence of CRKP positivity for the period after cohorting began showed a statistically significant change from the mean prevalence in the preceding period (P< .001).

Conclusions.

The cohorting of patients with dedicated staff, combined with implementation of focused active surveillance, effectively terminated the epidemic spread of CRKP. Cohorting reduced cross-infection within the hospital, and active surveillance allowed for earlier detection of carrier status. Both interventions should be considered in attempts to contain a hospital epidemic.

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Corresponding author
Division of Anaesthesia and Critical Care Medicine, Hadassah–Hebrew University Medical Center, POB 12000, Jerusalem, 91120, Israel (PhillipL@hadassah.org.il)
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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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