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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 ([email protected])
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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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