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Successful Control of an Outbreak of Klebsiella pneumoniae Carbapenemase—Producing K. pneumoniae at a Long-Term Acute Care Hospital

Published online by Cambridge University Press:  02 January 2015

L. Silvia Munoz-Price ,
Mary K. Hayden ,
Karen Lolans ,
Sarah Won ,
Karen Calvert ,
Michael Lin ,
Alexander Sterner  and
Robert A. Weinstein
L. Silvia Munoz-Price*
Affiliation:
Division of Infectious Diseases, University of Miami, Florida Jackson Memorial Hospital, Miami, Florida Munster, Alverno Laboratories, Hammond, Indiana
Mary K. Hayden
Affiliation:
Rush University, Chicago, Illinos
Karen Lolans
Affiliation:
Rush University, Chicago, Illinos
Sarah Won
Affiliation:
Rush University, Chicago, Illinos Stroger (Cook County) Hospital, Chicago, Illinos
Michael Lin
Affiliation:
Rush University, Chicago, Illinos
Alexander Sterner
Affiliation:
Munster, Alverno Laboratories, Hammond, Indiana
Robert A. Weinstein
Affiliation:
Rush University, Chicago, Illinos Stroger (Cook County) Hospital, Chicago, Illinos
*
Jackson Memorial Hospital, Park Plaza West L-302, 1611 Northwest 12th Avenue, Miami, PL 33136-1096 (smunozprice@med.miami.edu)
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Abstract

Objective.

To determine the effect of a bundle of infection control interventions on the horizontal transmission of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae during an outbreak.

Design.

Quasi-experimental study.

Setting.

Long-term acute care hospital.

Intervention.

On July 23,2008, a bundled intervention was implemented: daily 2% Chlorhexidine gluconate baths for patients, enhanced environmental cleaning, surveillance cultures at admission, serial point prevalence surveillance (PPS), isolation precautions, and training of personnel. Baseline PPS was performed before the intervention was implemented. Any gram-negative rod isolate suspected of KPC production underwent a modified Hodge test and, if results were positive, confirmatory polymerase chain reaction testing. Clinical cases were defined to occur for patients whose samples yielded KPC-positive gram-negative rods in clinical cultures.

Results.

Baseline PPS performed on June 17, 2008, showed a prevalence of colonization with KPC-producing isolates of 21% (8 of 39 patients screened). After implementation of the intervention, monthly PPS was performed 5 times, which showed prevalences of colonization with KPC-producing isolates of 12%, 5%, 3%, 0%, and 0% (P < .001). From January 1, 2008, until the intervention, 8 KPC-positive clinical cases—suspected to be due to horizontal transmission—were detected. From implementation of the intervention through December 31, 2008, only 2 KPC-positive clinical cases, both in August 2008, were detected. From January 1 through December 31, 2008, 8 patients were detected as carriers of KPC-producing isolates at admission to the institution, 4 patients before and 4 patients after the intervention.

Conclusion.

A bundled intervention was successful in preventing horizontal spread of KPC-producing gram-negative rods in a long-term acute care hospital, despite ongoing admission of patients colonized with KPC producers.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 4 , April 2010 , pp. 341 - 347
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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