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Active screening and interfacility communication of carbapenem-resistant Enterobacteriaceae (CRE) in a tertiary-care hospital

Published online by Cambridge University Press:  19 July 2018

Teppei Shimasaki Open the ORCID record for Teppei Shimasaki [Opens in a new window] ,
John Segreti ,
Alexander Tomich ,
Julie Kim ,
Mary K. Hayden ,
Michael Y. Lin  and
for the CDC Prevention Epicenters Program
Teppei Shimasaki*
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
John Segreti
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Alexander Tomich
Affiliation:
Infection Prevention and Control Department, Rush University Medical Center, Chicago, Illinois
Julie Kim
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Mary K. Hayden
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Michael Y. Lin
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
*
Address for correspondence: Teppei Shimasaki, MD, MS, 600 S Paulina St, Suite 143, Chicago, IL 60612. E-mail: shimasaki.t@gmail.com or Michael Y. Lin MD, MPH, 600 S Paulina St, Suite 143, Chicago, IL 60612. E-mail: Michael_Lin@rush.edu
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Abstract

Background

Hospitals may implement admission screening cultures and may review transfer documentation to identify patients colonized with carbapenem-resistant Enterobacteriaceae (CRE) to implement isolation precautions; however, outcomes and logistical considerations have not been well described.

Methods

At an academic hospital in Chicago, we retrospectively studied the implementation and outcomes of CRE admission screening from 2013 to 2016 during 2 periods. During period 1, we implemented active CRE rectal culture screening for all adults patients admitted to intensive care units (ICUs) and for those transferred from outside facilities to general wards. During period 2, screening was restricted only to adults transferred from outside facilities. For a subset of transferred patients who were previously reported to the health department as CRE positive, we reviewed transfer paperwork for appropriate documentation of CRE.

Results

Overall, 11,757 patients qualified for screening; rectal cultures were performed for 8,569 patients (73%). Rates of CRE screen positivity differed by period, previous facility type (if transferred), and current inpatient location. A higher combined CRE positivity rate was detected in the medical and surgical ICUs among period 2 patients (3.3%) versus all other ward-period comparisons (P<.001). Among 13 transferred patients previously known to be CRE colonized, appropriate CRE transfer documentation was available for only 4 patients (31%).

Conclusions

Active screening for CRE is feasible, and screening patients transferred from outside facilities to the medical or surgical ICU resulted in the highest screen positivity rate. Furthermore, CRE carriage was inconsistently documented in transfer paperwork, suggesting that admission screening or enhanced inter-facility communication are needed to improve the identification of CRE-colonized patients.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 9 , September 2018 , pp. 1058 - 1062
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION. Part of this study was presented at the SHEA Spring 2016 conference in Atlanta, Georgia, on May 20, 2016 (abstract no. 7835).

Cite this article: Shimasaki T, et al. (2018). Active screening and interfacility communication of carbapenem-resistant Enterobacteriaceae (CRE) in a tertiary-care hospital. Infection Control & Hospital Epidemiology 2018, 1–5. doi: 10.1017/ice.2018.150

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