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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...



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.


A prospective cohort interventional study.


Thirteen PACHs in Israel.


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.


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.


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


Corresponding author

National Center for Infection Control, Israel Ministry of Health, 6 Weizmann Street, Tel Aviv 64239, Israel (


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Members of the Post-Acute Care Hospital Carbapenem-Resistant Enterobacteriaceae Working Group are listed at the end of the text.



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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...


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