division of public health cre surveillance and prevention of transmission in healthcare settings
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Division of Public HealthCRE Surveillance and Prevention of Transmission in Healthcare Settings
Gwen Borlaug, CIC, MPHCoordinator, Healthcare-Associated Infections Prevention ProgramWSLH AST ConferenceMay 10, 2012
Key premise
The laboratory is a critical partner in preventing transmission of carbapenem-resistant Enterobacteriaceae (CRE) in healthcare settings.
Enterobacteriaceae
Gram negative bacteria usually residing in the GI tract
Ferment glucose Examples
– Klebsiella spp.– E. coli– Enterobacter spp.– Serratia marcescens– Citrobacter spp. – Proteus spp.
Enterobacteriaceae
E. coli, Klebsiella spp., and Enterobacter
spp. made up 21% of all healthcare-associated infections (HAI) in 2006-07.
Hidron et al. Infect Control Hosp Epidemiol 2008;29:996-1011
CRE
Important healthcare-associated pathogens Resistant to almost all antimicrobial agents Infections associated with high morbidity and
mortality Present in US hospitals since 1999, routinely
recovered in NY and NJ hospitals From 2000-2007, HAI data reported to CDC indicate
the percentage of CR Klebsiella isolates increased from 1% to 8%
Sporadic cases known to occur in WI
Rationale for action
Because these organisms pose a threat to patients in acute care settings, are difficult to treat and cause increased mortality, cost, and length of stay, CDC is urging state health departments to determine prevalence and contain these organisms before they become endemic.
Statewide surveillance
In Wisconsin, the approach is to determine prevalence in acute care facilities using the National Healthcare Safety Network, to detect patients with CRE infections/colonization quickly through recommended laboratory methods, and to promptly apply strict infection control methods.
Surveillance design
Active surveillance for CR Klebsiella spp. and for CR E. coli based on unique clinical isolates detected per inpatient per month in each facility
6 months: December 1, 2011-May 31, 2012 All WI acute care, critical access, and long-term care
hospitals (n = 137)– Includes specialty acute care such as children’s,
orthopedic, heart– Excludes behavioral, AODA, psychiatric, rehabilitation
hospitals
Findings to date
11 reported events; 8 cases– 5 cases from same acute care facility, 4 of which
were residents of same LTC facility– 5th case was a patient on same unit as a resident
from the LTC facility– PFGE analysis suggests transmission within the LTC
facility and transmission in the acute care facility Remaining 6 events represent 3 sporadic cases
Preventing transmission of CRE
Strict contact precautions for all known infected and colonized patients
Regional collaboration and communication across all healthcare settings
Active surveillance testing in certain situations
Advanced measures when needed (e.g. cohorting of patients, staff)
Reference
Centers for Disease Control and Prevention. Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute
care facilities. MMWR 58 (10); 256-260
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5810a4.htm
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