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Institutional Control Measures to Curtail the Epidemic Spread of Carbapenem-Resistant Klebsiella pneumoniae: A 4-Year Perspective

Published online by Cambridge University Press:  02 January 2015

Matan J. Cohen ,
Colin Block ,
Phillip D. Levin ,
Carmela Schwartz ,
Ilana Gross ,
Yuval Weiss ,
Allon E. Moses  and
Shmuel Benenson
Matan J. Cohen
Affiliation:
Center for Clinical Quality and Safety, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
Colin Block
Affiliation:
Department of Clinical Microbiology and Infectious Diseases, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
Phillip D. Levin*
Affiliation:
Division of Anaesthesia and Critical Care Medicine, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
Carmela Schwartz
Affiliation:
Department of Clinical Microbiology and Infectious Diseases, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
Ilana Gross
Affiliation:
Department of Clinical Microbiology and Infectious Diseases, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
Yuval Weiss
Affiliation:
Directorate, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
Allon E. Moses
Affiliation:
Department of Clinical Microbiology and Infectious Diseases, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
Shmuel Benenson
Affiliation:
Department of Clinical Microbiology and Infectious Diseases, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
*
Division of Anaesthesia and Critical Care Medicine, Hadassah–Hebrew University Medical Center, POB 12000, Jerusalem, 91120, Israel (PhillipL@hadassah.org.il)
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Abstract

Objective.

To describe the implementation of an institution-wide, multiple-step intervention to curtail the epidemic spread of carbapenem-resistant Klebsiella pneumoniae (CRKP).

Design.

Consecutive intervention analyses.

Patients and Setting.

All patients admitted to a 775-bed tertiary care medical center in Jerusalem, Israel, from 2006 through 2010.

Interventions.

The effects of 4 interventions were assessed: (1) a policy of isolation for patients colonized or infected with CRKP in single rooms, which was started in March 2006; (2) cohorting of CRKP patients with dedicated nursing staff and screening of patients neighboring a patient newly identified as a carrier of CRKP, which was started in March 2007; (3) weekly active surveillance of intensive care unit patients, which was started during August 2008; and (4) selective surveillance of patients admitted to the emergency department, which was started in March 2009. Interrupted regression analysis and change-point analysis were used to assess the effect of each intervention on the CRKP epidemic.

Results.

Patient isolation alone failed to control the spread of CRKP, with incidence increasing to a peak of 30 new cases per 1,000 hospital beds per month. Institution of patient cohorting led to a steep decline in the incidence of CRKP acquisition (P< .001). Introduction of active surveillance interventions was followed by a decrease in the incidence of CRKP-positive clinical cultures but an increase in the incidence of CRKP-positive screening cultures. The mean prevalence of CRKP positivity for the period after cohorting began showed a statistically significant change from the mean prevalence in the preceding period (P< .001).

Conclusions.

The cohorting of patients with dedicated staff, combined with implementation of focused active surveillance, effectively terminated the epidemic spread of CRKP. Cohorting reduced cross-infection within the hospital, and active surveillance allowed for earlier detection of carrier status. Both interventions should be considered in attempts to contain a hospital epidemic.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 7 , July 2011 , pp. 673 - 678
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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References

1.Leavitt, A, Navon-Venezia, S, Chmelnitsky, I, Schwaber, MJ, Carmeli, Y. Emergence of KPC-2 and KPC-3 in carbapenem-resistant Klebsiella pneumoniae strains in an Israeli hospital. Antimicrob Agents Chemother 2007;51:3026–3029.CrossRefGoogle Scholar
2.Schwaber, MJ, Carmeli, Y. Carbapenem-resistant Enterobacteriaceae: a potential threat. JAMA 2008;300:2911–2913.Google Scholar
3.Murray, PR, Baron, EJ. Manual of Clinical Microbiology. 9th ed. Washington, DC: ASM Press; 2007.Google Scholar
4.Cockerill, FR, Wikler, MA, Bush, K, et al. Performance standards for antimicrobial susceptibility testing; twentieth informational supplement (June 2010 update). Wayne, PA: Clinical and Laboratory Standards Institute; 2010.Google Scholar
5.Wikler, MA, Cockerill, FR, Bush, K, et al. Performance standards for antimicrobial disk susceptibility tests: approved standard, 10th ed. Wayne, PA: Clinical and Laboratory Standards Institute; 2009.Google Scholar
6.Anderson, KF, Lonsway, DR, Rasheed, JK, et al. Evaluation of methods to identify the Klebsiella pneumoniae carbapenemase in Enterobacteriaceae. J Clin Microbiol 2007;45:2723–2725.CrossRefGoogle ScholarPubMed
7.Samra, Z, Bahar, J, Madar-Shapiro, L, Aziz, N, Israel, S, Bishara, J. Evaluation of CHROMagar KPC for rapid detection of carbapenem-resistant Enterobacteriaceae. J Clin Microbiol 2008;46:3110–3111.CrossRefGoogle ScholarPubMed
8.Navon-Venezia, S, Chmelnitsky, I, Leavitt, A, Schwaber, MJ, Schwartz, D, Carmeli, Y. Plasmid-mediated imipenem-hydrolyzing enzyme KPC-2 among multiple carbapenem-resistant Escherichia coli clones in Israel. Antimicrob Agents Chemother 2006;50:3098–3101.CrossRefGoogle ScholarPubMed
9.Shardell, M, Harris, A, El-Karamy, S, Furuno, J, Miller, R, Perencevich, E. Statistical analysis and application of quasi experiments to antimicrobial resistance intervention studies. Clin Infectious Dis 2007;45:901–907.Google Scholar
10.Harbarth, S, Samore, M. Interventions to control MRSA: high time for time series analysis? J Antimicrob Chemother 2008;62:431–433.Google Scholar
11.Wagner, A, Soumrai, A. Segmented regression analysis of interrupted time series studies in medication use research. J Clinical Pharm Therapeutics 2002;27.CrossRefGoogle ScholarPubMed
12.Chib, S. Estimation and comparison of multiple change-point models. J Econometrics 1998;86:221–241.CrossRefGoogle Scholar
13.Murray-Leisure, K, Geib, S, Graceley, D, et al. Control of epidemic methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 1990;11:343–350.Google Scholar
14.Montecalvo, M, Jarvis, W, Uman, J, et al. Infection-control measures reduce transmission of vancomycin resistant enterococci in an endemic setting. Ann Intern Med 1999;131:269–272.CrossRefGoogle Scholar
15.Jochimsen, E, Fish, L, Manning, K, et al. Control of vancomycin-resistant enterococci at a community hospital: efficacy of patient and staff cohorting. Infect Control Hosp Epidemiol 1999;20:106–109.Google Scholar
16.Sample, M, Gravel, D, Oxley, C, Toye, B, Garber, G, Ramotar, K. An outbreak of vancomycin-resistant enterococci in a hematology-oncology unit: control by patient cohorting and terminal cleaning of the environment. Infect Control Hosp Epidemiol 2002;23:468–470.CrossRefGoogle Scholar
17.Zawacki, A, O'Rourke, E, Potter-Bynoe, G, Macone, A, Harbarth, S, Goldman, D. An outbreak of Pseudomonas aeruginosa and bloodstream infection associated with intermittent otitis externa in a healthcare worker. Infect Control Hosp Epidemiol 2004;25:1083–1089.Google Scholar
18.Gregory, C, Llata, E, Stine, N, et al. Outbreak of carbapenem-resistant Klebsiella pneumonia in Puerto Rico associated with a novel carbapenemase variant. Infect Control Hosp Epidemiol 2010;31:476–484.Google Scholar
19.Urban, C, Segal-Maurer, S, Rahal, J. Considerations in control and treatment of nosocomial infections due to multidrug-resistant Acinetobacter baumannii. Clin Infect Dis 2003;36:1268–1274.CrossRefGoogle ScholarPubMed
20.Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities. MMWR Morb Mortal Wkly Rep 2009;58:256–260.Google Scholar
21.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Healthcare Infection Control Practices Advisory Committee (HICPAC). 2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35:S65–S164.CrossRefGoogle Scholar