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

Published online by Cambridge University Press:  10 May 2016

Debby Ben-David*
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
Samira Masarwa
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
Amos Adler
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
Hagit Mishali
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
Yehuda Carmeli
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
Mitchell J. Schwaber
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
National Center for Infection Control, Israel Ministry of Health, 6 Weizmann Street, Tel Aviv 64239, Israel (



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.

Original Article
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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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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