Skip to main content
×
Home
    • Aa
    • Aa

A National Intervention to Prevent the Spread of Carbapenem-Resistant Enterobacteriaceae in Israeli Post-Acute Care Hospitals

  • Debby Ben-David (a1), Samira Masarwa (a1), Amos Adler (a1), Hagit Mishali (a1), Yehuda Carmeli (a1), Mitchell J. Schwaber (a1) and the Post-Acute Care Hospital Carbapenem-Resistant Enterobacteriaceae Working Group...
Abstract
Objective

Patients hospitalized in post-acute care hospitals (PACHs) constitute an important reservoir of antimicrobial-resistant bacteria. High carriage prevalence of carbapenem-resistant Enterobacteriaceae (CRE) has been observed among patients hospitalized in PACHs. The objective of the study is to describe the impact of a national infection control intervention on the prevalence of CRE in PACHs.

Design

A prospective cohort interventional study.

Setting

Thirteen PACHs in Israel.

Intervention

A multifaceted intervention was initiated between 2008 and 2011 as part of a national program involving all Israeli healthcare facilities. The intervention has included (1) periodic on-site assessments of infection control policies and resources, using a score comprised of 16 elements; (2) assessment of risk factors for CRE colonization; (3) development of national guidelines for CRE control in PACHs involving active surveillance and contact isolation of carriers; and (4) 3 cross-sectional surveys of rectal carriage of CRE that were conducted in representative wards.

Results

The infection control score increased from 6.8 to 14.0 (P < .001) over the course of the study period. A total of 3,516 patients were screened in the 3 surveys. Prevalence of carriage among those not known to be carriers decreased from 12.1% to 7.9% (P = .008). Overall carrier prevalence decreased from 16.8% to 12.5% (P = .013). Availability of alcohol-based hand rub, appropriate use of gloves, and a policy of CRE surveillance at admission to the hospital were independently associated with lower new carrier prevalence.

Conclusion

A nationwide infection control intervention was associated with enhanced infection control measures and a reduction in the prevalence of CRE in PACHs.

Copyright
Corresponding author
National Center for Infection Control, Israel Ministry of Health, 6 Weizmann Street, Tel Aviv 64239, Israel (debby.bendavid@sheba.health.gov.il).
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1. CV Gould , R Rothenberg , JP Steinberg . Antibiotic resistance in long-term acute care hospitals: the perfect storm. Infect Control Hosp Epidemiol 2006;27(9):920925.

2. LS Munoz-Price . Long-term acute care hospitals. Clin Infect Dis 2009;49(3):438443.

3. JP Furuno , JN Hebden , HC Standiford , et al. Prevalence of methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii in a long-term acute care facility. Am J Infect Control 2008;36(7):468471.

4. C Stephens , SJ Francis , V Abell , JR DiPersio , P Wells . Emergence of resistant Acinetobacter baumannii in critically ill patients within an acute care teaching hospital and a long-term acute care hospital. Am J Infect Control 2007;35(4):212215.

5. SL Barnes , AD Harris , BL Golden , EA Wasil , JP Furuno . Contribution of interfacility patient movement to overall methicillin-resistant Staphylococcus aureus prevalence levels. Infect Control Hosp Epidemiol 2011;32(11):10731078.

6. LS Munoz-Price , A Stemer . Four years of surveillance cultures at a long-term acute care hospital. Infect Control Hosp Epidemiol 2010;31(1):5963.

7. JM Kahn , NM Benson , D Appleby , SS Carson , TJ Iwashyna . Long-term acute care hospital utilization after critical illness. JAMA 2010;303(22):22532259.

8. LE Nicolle . Infection control in long-term care facilities. Clin Infect Dis 2000;31(3):752756.

9. BJ Roup , JC Roche , M Pass . Infection control program disparities between acute and long-term care facilities in Maryland. Am J Infect Control 2006;34(3):122127.

10. M Jones , MH Samore , M Carter , MA Rubin . Long-term care facilities in Utah: a description of human and information technology resources applied to infection control practice. Am J Infect Control 2012;40(5):446450.

12. P Nordmann , T Naas , L Poirel . Global spread of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis 2011;17(10):17911798.

13. G Cuzon , T Naas , H Truong , et al. Worldwide diversity of Klebsiella pneumoniae that produce beta-lactamase blaKPC-2 gene. Emerg Infect Dis 2010;16(9):13491356.

14. P Nordmann , G Cuzon , T Naas . The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis 2009;9(4):228236.

15. S Navon-Venezia , A Leavitt , MJ Schwaber , et al. First report on a hyperepidemic clone of KPC-3-producing Klebsiella pneumoniae in Israel genetically related to a strain causing outbreaks in the United States. Antimicrob. Agents Chemother 2009;53(2):818820.

17. Z Samra , O Ofir , Y Lishtzinsky , L Madar-Shapiro , J Bishara . Outbreak of carbapenem-resistant Klebsiella pneumoniae producing KPC-3 in a tertiary medical centre in Israel. Int J Antimicrob Agents 2007;30(6):525529.

19. MJ Schwaber , B Lev , A Israeli , et al. Containment of a country-wide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention. Clin Infect Dis 2011;52(7):848855.

20. D Ben-David , S Masarwa , S Navon-Venezia , et al. Carbapenem-resistant Klebsiella pneumoniae in post-acute-care facilities in Israel. Infect Control Hosp Epidemiol 2011;32(9):845853.

22. D Pittet , B Allegranzi , J Boyce ; World Health Organization World Alliance for Patient Safety First Global Patient Safety Challenge Core Group of Experts. The World Health Organization guidelines on hand hygiene in health care and their consensus recommendations. Infect Control Hosp Epidemiol 2009;30(7):611622.

23. JD Siegel , E Rhinehart , M Jackson , L Chiarello ; Health Care Infection Control Practices Advisory Committee. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35(10 suppl 2):S65S164.

24. BE Ostrowsky , WE Trick , AH Sohn , et al. Control of vancomycin-resistant enterococcus in health care facilities in a region. N Engl J Med 2001;344(19):14271433.

25. AS Chitnis , PS Caruthers , AK Rao , et al. Outbreak of carbapenem-resistant Enterobacteriaceae at a long-term acute care hospital: sustained reductions in transmission through active surveillance and targeted interventions. Infect Control Hosp Epidemiol 2012;33(10):984992.

26. J Oteo , C Navarro , E Cercenado , et al. Spread of Escherichia coli strains with high-level cefotaxime and ceftazidime resistance between the community, long-term care facilities, and hospital institutions. J Clin Microbiol 2006;44(7):23592366.

27. RA Viau , AM Hujer , SH Marshall , et al. “Silent” dissemination of Klebsiella pneumoniae isolates bearing K. pneumoniae carbapenemase in a long-term care facility for children and young adults in northeast Ohio. Clin Infect Dis 2012;54(9):13141321.

28. SY Won , LS Munoz-Price , K Lolans , B Hota , RA Weinstein , MK Hayden . Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemasea producing Enterobacteriaceae. Clin Infect Dis 2011;53(6):532540.

30. D Marchaim , T Chopra , C Bogan , et al. The burden of multidrug-resistant organisms on tertiary hospitals posed by patients with recent stays in long-term acute care facilities. Am J Infect Control 2012;40(8):760765.

31. K Prabaker , MY Lin , M McNally , et al. Transfer from high-acuity long-term care facilities is associated with carriage of Klebsiella pneumoniae carbapenemase-producing Enterobacteriacea: a multihospital study. Infect Control Hosp Epidemiol 2012;33(12):11931199.

32. MJ Schwaber , Y Carmeli . An ongoing national intervention to contain the spread of carbapenem-resistant Enterobacteriaceae. Clin Infect Dis 2014;58(5):697703

33. V Jarlier , D Trystram , C Brun-Buisson , et al. Curbing methicillin-resistant Staphylococcus aureus in 38 French hospitals through a 15-year institutional control program. Arch Intern Med 2010;170(6):552559.

34. LE Nicolle . Antimicrobial resistance in long-term care facilities. Future Microbiol 2012;7(2):171174.

35. D Calfee , SG Jenkins . Use of active surveillance cultures to detect asymptomatic colonization with carbapenem-resistant Klebsiella pneumoniae in intensive care unit patients. Infect Control Hosp Epidemiol 2008;29(10):966968.

36. D Ben-David , Y Maor , N Keller , et al. Potential role of active surveillance in the control of a hospital-wide outbreak of carbapenem-resistant Klebsiella pneumoniae infection. Infect Control Hosp Epidemiol 2010;31(6):620626.

37. P Ciobotaro , M Oved , E Nadir , R Bardenstein , O Zimhony . An effective intervention to limit the spread of an epidemic carbapenem-resistant Klebsiella pneumoniae strain in an acute care setting: from theory to practice. Am J Infect Control 2011;39(8):671677.

38. S Kochar , T Sheard , R Sharma , et al. Success of an infection control program to reduce the spread of carbapenem-resistant Klebsiella pneumoniae. Infect Control Hosp Epidemiol 2009;30(5):447452.

39. CJ Thurlow , K Prabaker , MY Lin , K Lolans , RA Weinstein , MK Hayden . Anatomic sites of patient colonization and environmental contamination with Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae at long-term acute care hospitals. Infect Control Hosp Epidemiol 2013;34(1):5661.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 60 *
Loading metrics...

Abstract views

Total abstract views: 193 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 19th August 2017. This data will be updated every 24 hours.