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Regional Impact of a CRE Intervention Targeting High Risk Postacute Care Facilities (Chicago PROTECT)

Published online by Cambridge University Press:  02 November 2020

Michael Lin
Affiliation:
Rush University Medical Center
Mary Carl Froilan
Affiliation:
Rush University Medical Center
Jinal Makhija
Affiliation:
Rush University Medical Center
Ellen Benson
Affiliation:
Rush University Medical Center
Sarah Bartsch
Affiliation:
City University of New York
Pamela B. Bell
Affiliation:
Rush University Medical Center
Stephanie Black
Affiliation:
Chicago Dept of Public Health
Deborah Burdsall
Affiliation:
Baldwin Hill Solutions LLC
Michelle Ealy
Affiliation:
Illinois Dept of Public Health
Anthony Fiore
Affiliation:
The Centers for Disease Control and Prevention, Division of Healthcare Quality and Promotion
Sharon Foy
Affiliation:
Stickney Public Health District
Mabel Frias
Affiliation:
Cook County Department of Public Health
Alice Han
Affiliation:
Metro Infectious Disease Consultants
David Hines
Affiliation:
Metro Infectious Disease Consultants
Olufemi Jegede
Affiliation:
Cook County Dept of Public Health
John Jernigan
Affiliation:
Centers for Disease Control and Prevention
Sarah K. Kemble
Affiliation:
Chicago Department of Public Health
Mary Alice Lavin
Affiliation:
Lavin Consulting, LLC
Bruce Lee
Affiliation:
City University of New York
George Markovski
Affiliation:
Cook County Health
Massimo Pacilli
Affiliation:
Chicago Department of Public Health
Sujan Reddy
Affiliation:
CDC
Erica Runningdeer
Affiliation:
Illinois Department of Public Health
Michael Schoeny
Affiliation:
Rush University Medical Center
Mitali Shah
Affiliation:
Rush University Medical Center
Rachel Slayton
Affiliation:
Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion
Elizabeth Soda
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC
Nimalie Stone
Affiliation:
The Centers for Disease Control and Prevention, Division of Healthcare Quality and Promotion
Angela S. Tang
Affiliation:
Illinois Department of Public Health
Karen Trimberger
Affiliation:
APIC
Marion Tseng
Affiliation:
Medical Research Analytics and Informatics Alliance
Yingxu Xiang
Affiliation:
Cook County Health
Robert Weinstein
Affiliation:
Rush University Medical Center
William Trick
Affiliation:
Cook County Health
Mary Hayden
Affiliation:
Rush University Medical Center
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Abstract

Background: Carbapenem-resistant Enterobacteriaceae (CRE) are endemic in the Chicago region. We assessed the regional impact of a CRE control intervention targeting high-prevalence facilities; that is, long-term acute-care hospitals (LTACHs) and ventilator-capable skilled nursing facilities (vSNFs). Methods: In July 2017, an academic–public health partnership launched a regional CRE prevention bundle: (1) identifying patient CRE status by querying Illinois’ XDRO registry and periodic point-prevalence surveys reported to public health, (2) cohorting or private rooms with contact precautions for CRE patients, (3) combining hand hygiene adherence, monitoring with general infection control education, and guidance by project coordinators and public health, and (4) daily chlorhexidine gluconate (CHG) bathing. Informed by epidemiology and modeling, we targeted LTACHs and vSNFs in a 13-mile radius from the coordinating center. Illinois mandates CRE reporting to the XDRO registry, which can also be manually queried or generate automated alerts to facilitate interfacility communication. The regional intervention promoted increased automation of alerts to hospitals. The prespecified primary outcome was incident clinical CRE culture reported to the XDRO registry in Cook County by month, analyzed by segmented regression modeling. A secondary outcome was colonization prevalence measured by serial point-prevalence surveys for carbapenemase-producing organism colonization in LTACHs and vSNFs. Results: All eligible LTACHs (n = 6) and vSNFs (n = 9) participated in the intervention. One vSNF declined CHG bathing. vSNFs that implemented CHG bathing typically bathed residents 2–3 times per week instead of daily. Overall, there were significant gaps in infection control practices, especially in vSNFs. Also, 75 Illinois hospitals adopted automated alerts (56 during the intervention period). Mean CRE incidence in Cook County decreased from 59.0 cases per month during baseline to 40.6 cases per month during intervention (P < .001). In a segmented regression model, there was an average reduction of 10.56 cases per month during the 24-month intervention period (P = .02) (Fig. 1), and an estimated 253 incident CRE cases were averted. Mean CRE incidence also decreased among the stratum of vSNF/LTACH intervention facilities (P = .03). However, evidence of ongoing CRE transmission, particularly in vSNFs, persisted, and CRE colonization prevalence remained high at intervention facilities (Table 1). Conclusions: A resource-intensive public health regional CRE intervention was implemented that included enhanced interfacility communication and targeted infection prevention. There was a significant decline in incident CRE clinical cases in Cook County, despite high persistent CRE colonization prevalence in intervention facilities. vSNFs, where understaffing or underresourcing were common and lengths of stay range from months to years, had a major prevalence challenge, underscoring the need for aggressive infection control improvements in these facilities.

Funding: The Centers for Disease Control and Prevention (SHEPheRD Contract No. 200-2011-42037)

Disclosures: M.Y.L. has received research support in the form of contributed product from OpGen and Sage Products (now part of Stryker Corporation), and has received an investigator-initiated grant from CareFusion Foundation (now part of BD).

Type
Oral Presentations
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Regional Impact of a CRE Intervention Targeting High Risk Postacute Care Facilities (Chicago PROTECT)
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