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A Multifaceted Intervention Strategy for Eradication of a Hospital-Wide Outbreak Caused by Carbapenem-Resistant Klebsiella pneumoniae in Southern Israel

Published online by Cambridge University Press:  02 January 2015

Abraham Borer ,
Seada Eskira ,
Ronit Nativ ,
Lisa Saidel-Odes ,
Klaris Riesenberg ,
Ilana Livshiz-Riven ,
Francisc Schlaeffer ,
Michael Sherf  and
Nejama Peled
Abraham Borer*
Affiliation:
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Seada Eskira
Affiliation:
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Ronit Nativ
Affiliation:
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Lisa Saidel-Odes
Affiliation:
Infectious Diseases Institute, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Klaris Riesenberg
Affiliation:
Infectious Diseases Institute, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Ilana Livshiz-Riven
Affiliation:
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Francisc Schlaeffer
Affiliation:
Infectious Diseases Institute, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Michael Sherf
Affiliation:
Hospital Administration, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Nejama Peled
Affiliation:
Clinical Microbiology Laboratory, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
*
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, PO Box 151, Beer-Sheva 84101, Israel ([email protected])
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Abstract

Objective.

To devise a local strategy for eradication of a hospital-wide outbreak caused by carbapenem-resistant Klebsiella pneumoniae (CRKP).

Design.

Quasi-experimental, before-and-after, interrupted time-series study.

Setting.

A 1,000-bed tertiary-care university teaching hospital.

Methods.

Retrospectively, all relevant data were collected from the medical records of patients with CRKP infections from May 2006 through April 2007, the preintervention period. From May 1, 2007, through May 1, 2010, the postintervention period, the intervention was applied and prospectively followed. The 5 key elements of this strategy were an emergency department flagging system, the building of a cohort ward, the eradication of clusters, environmental and personnel hand cultures, and a carbapenem-restriction policy. The demographic and clinical parameters of patients colonized by and/or infected with CRKP were collected from medical records.

Results.

A total of 10,680 rectal cultures were performed for 8,376 patients; 433 (5.16%) and 370 (4.4%) were CRKP-colonized and CRKP-infected patients, respectively, and 789 (98%) of 803 patients were admitted to the CRKP cohort ward. The CRKP infection density was reduced from 5.26 to 0.18 per 10,000 patient-days (P<.001), and no nosocomial CRKP infections were diagnosed. Twenty-three percent of environmental cultures were found to be positive. Meropenem use was reduced from 283 ± 70.92 to 118 ± 74.32 defined daily doses per 1,000 patient-days (P<.001).

Conclusion.

This intervention produced an enormous impact on patient location, surveillance cultures, and antibiotic policies and a massive investment in infection control resources.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 12 , December 2011 , pp. 1158 - 1165
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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