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A Model-Based Strategy to Control the Spread of Carbapenem-Resistant Enterobacteriaceae: Simulate and Implement

Published online by Cambridge University Press:  09 September 2016

Mirian de Freitas DalBen ,
Elisa Teixeira Mendes ,
Maria Luisa Moura ,
Dania Abdel Rahman ,
Driele Peixoto ,
Sania Alves dos Santos ,
Walquiria Barcelos de Figueiredo ,
Pedro Vitale Mendes ,
Leandro Utino Taniguchi  and
Francisco Antonio Bezerra Coutinho
...Show all authors
Mirian de Freitas DalBen*
Affiliation:
Infection Control Department and LIM54, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil Department of Infectious Diseases and Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
Elisa Teixeira Mendes
Affiliation:
Infection Control Department and LIM54, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil Department of Infectious Diseases and Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
Maria Luisa Moura
Affiliation:
Infection Control Department and LIM54, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
Dania Abdel Rahman
Affiliation:
Infection Control Department and LIM54, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
Driele Peixoto
Affiliation:
Infection Control Department and LIM54, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
Sania Alves dos Santos
Affiliation:
Infection Control Department and LIM54, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil Department of Infectious Diseases and Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
Walquiria Barcelos de Figueiredo
Affiliation:
Nursing Division, Faculty of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
Pedro Vitale Mendes
Affiliation:
Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
Leandro Utino Taniguchi
Affiliation:
Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
Francisco Antonio Bezerra Coutinho
Affiliation:
Discipline of Medical Informatics, School of Medicine, University of São Paulo, São Paulo, Brazil
Eduardo Massad
Affiliation:
Discipline of Medical Informatics, School of Medicine, University of São Paulo, São Paulo, Brazil
Anna Sara Levin
Affiliation:
Infection Control Department and LIM54, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil Department of Infectious Diseases and Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
*
Address correspondence to Mirian F. DalBen, MD, Department of Infection Control of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Frei Caneca, 640/252-Vereda, São Paulo, Brazil 01307-000 ([email protected]).
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Abstract

OBJECTIVE

To reduce transmission of carbapenem-resistant Enterobacteriaceae (CRE) in an intensive care unit with interventions based on simulations by a developed mathematical model.

DESIGN

Before-after trial with a 44-week baseline period and 24-week intervention period.

SETTING

Medical intensive care unit of a tertiary care teaching hospital.

PARTICIPANTS

All patients admitted to the unit.

METHODS

We developed a model of transmission of CRE in an intensive care unit and measured all necessary parameters for the model input. Goals of compliance with hand hygiene and with isolation precautions were established on the basis of the simulations and an intervention was focused on reaching those metrics as goals. Weekly auditing and giving feedback were conducted.

RESULTS

The goals for compliance with hand hygiene and contact precautions were reached on the third week of the intervention period. During the baseline period, the calculated R0 was 11; the median prevalence of patients colonized by CRE in the unit was 33%, and 3 times it exceeded 50%. In the intervention period, the median prevalence of colonized CRE patients went to 21%, with a median weekly Rn of 0.42 (range, 0–2.1).

CONCLUSIONS

The simulations helped establish and achieve specific goals to control the high prevalence rates of CRE and reduce CRE transmission within the unit. The model was able to predict the observed outcomes. To our knowledge, this is the first study in infection control to measure most variables of a model in real life and to apply the model as a decision support tool for intervention.

Infect Control Hosp Epidemiol 2016;1–8

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 11 , November 2016 , pp. 1315 - 1322
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Gupta, N, Limbago, BM, Patel, JB, Kallen, AJ. Carbapenem-resistant Enterobacteriaceae: epidemiology and prevention. Clin Infect Dis 2011;53:60–67.CrossRefGoogle ScholarPubMed
2. Gaynes, RP, Culver, DH. Resistance to imipenem among selected gram-negative bacilli in the United States. Infect Control Hosp Epidemiol 1992;13:10–14.Google Scholar
3. Sievert, DM, Ricks, P, Edwards, JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infect Control Hosp Epidemiol 2013;34:1–14.Google Scholar
4. Rossi, F. The challenges of antimicrobial resistance in Brazil. Clin Infect Dis 2011;52:1138–1143.Google Scholar
5. Sypsa, V, Psichogiou, M, Bouzala, GA, et al. Transmission dynamics of carbapenemase-producing Klebsiella pneumoniae and anticipated impact of infection control strategies in a surgical unit. PLOS ONE 2012;e41068.CrossRefGoogle ScholarPubMed
6. Cooper, BS, Medley, GF, Scott, GM. Preliminary analysis of the transmission dynamics of nosocomial infections: stochastic and management effects. J Hosp Infect 1999;43:131–147.Google Scholar
7. van Kleef, E, Robotham, JV, Jit, M, Deeny, SR, Edmunds, WJ. Modelling the transmission of healthcare associated infections: a systematic review. BMC Infect Dis 2013;13:294–307.Google Scholar
8. Feldman, N, Adler, A, Molshatzki, N, et al. Gastrointestinal colonization by KPC-producing Klebsiella pneumoniae following hospital discharge: duration of carriage and risk factors for persistent carriage. Clin Microbiol Infect 2013;19:E190–E196.Google Scholar
9. Zimmerman, FS, Assous, MV, Bdolah-Abram, T, Lachish, T, Yinnon, AM, Wiener-Well, Y. Duration of carriage of carbapenem-resistant Enterobacteriaceae following hospital discharge. Am J Infect Control 2013;41:190–194.Google Scholar
10. Massad, E, Coutinho, FAB, Yang, HM, de Carvalho, HB, Mesquita, F, Burattini, MN. The basic reproduction ratio of HIV among intravenous-drug-users. Math Biosci 1994;23:227–247.CrossRefGoogle Scholar
11. World Health Organization. WHO guidelines on hand hygiene in health care. World Health Organization website. http://apps.who.int/iris/bitstream/10665/44102/1/9789241597906_eng.pdf. Published 2009. Acessed December 29, 2015.Google Scholar
12. Larson, EL, Strom, MS, Evans, CA. Analysis of three variables in sampling solutions used to assay bacteria of hands: type of solution, use of antiseptic neutralizers, and solution temperature. J Clin Microbiol 1980;12:355–360.Google Scholar
13. Ivers, N, Jamtvedt, G, Flottorp, S, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2012;13:CD000259.Google Scholar
14. Swaminathan, M, Sharma, S, Poliansky, BS, et al. Prevalence and risk factors for acquisition of carbapenem-resistant Enterobacteriaceae in the setting of endemicity. Infect Control Hosp Epidemiol 2013;34:809–817.Google Scholar
15. Bhargava, A, Hayakawa, K, Silverman, E, et al. Risk factors for colonization due to carbapenem-resistant Enterobacteriaceae among patients exposed to long-term acute care and acute care facilities. Infect Control Hosp Epidemiol 2014;35:398–405.Google Scholar
16. Pereira, GH, Garcia, DO, Mostardeiro, M, Fanti, KSVN, Levin, AS. Outbreak of carbapenem-resistant Klebsiella pneumoniae: two-year epidemiologic follow-up in a tertiary hospital. Mem Inst Oswaldo Cruz 2013;108:113–115.Google Scholar
17. D’Agata, EM, Webb, G, Horn, M. A mathematical model quantifying the impact of antibiotic exposure and other interventions on the endemic prevalence of vancomycin-resistant enterococci. J Infect Dis 2005;192:2004–2011.CrossRefGoogle ScholarPubMed
18. Lin, MY, Lolans, K, Blom, DW, et al. The effectiveness of routine daily chlorhexidine gluconate bathing in reducing Klebsiella pneumoniae carbapenemase–producing Enterobacteriaceae skin burden among long-term acute care hospital patients. Infect Control Hosp Epidemiol 2014;35:440–442.Google Scholar
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