Success of a National Intervention in Controlling Carbapenem-resistant Enterobacteriaceae in Israel's Long-term Care Facilities

• Published in: Clinical infectious diseases 2019-03, Vol.68 (6), p.964-971
• Main Authors: Ben-David, Debby, Masarwa, Samira, Fallach, Noga, Temkin, Elizabeth, Solter, Ester, Carmeli, Yehuda, Schwaber, Mitchell J
• Format: Article
• Language: English
• Subjects: Carbapenem-Resistant Enterobacteriaceae; Cross Infection - epidemiology; Cross Infection - microbiology; Enterobacteriaceae Infections - drug therapy; Enterobacteriaceae Infections - epidemiology; Enterobacteriaceae Infections - microbiology; Enterobacteriaceae Infections - prevention & control; Health Facilities; Hospitals; Humans; Incidence; Israel - epidemiology; Long-Term Care; Nursing Homes; Prevalence; Skilled Nursing Facilities
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciy572

Abstract Background Long-term care facilities (LTCFs) are a major reservoir of carbapenem-resistant Enterobacteriaceae (CRE) in healthcare facilities, contributing to rapid regional dissemination of CRE. Methods In 2008, The Israeli National Center for Infection Control (NCIC) initiated a coordinated, comprehensive intervention in Israel's LTCFs, encompassing approximately 25000 beds in over 300 institutions. The intervention included implementation of population-tailored contact precautions and early detection of carriers. The NCIC established a real-time repository of all CRE carriers and events of acquisition, supervised information exchange between healthcare facilities and directed intervention at the institutional level during local outbreaks. CRE incidence was determined based on detection of CRE, either during LTFC stay or on admission to another facility. Prevalence was determined by a series of 5 cross-sectional surveys commenced between 2008 and 2015. Results From January 2009 through December 2015, 5265 patients acquired CRE in LTCFs. During the study period, incidence of acquisition declined in all facility types, to approximately 50% of the baseline (P < .001). The number of skilled nursing facilities and nursing homes experiencing ≥ 5 CRE acquisitions annually decreased from 35 to 11 during this period. The point prevalence of newly detected CRE carriage in post-acute care hospitals decreased from 12.3% in the survey commenced in 2008 to 0.8% in that begun in 2015 (P < .001). Conclusions A national, coordinated intervention resulted in a sustained decrease in CRE incidence and prevalence in LTCFs. These results support the assumption that centrally coordinated intervention is an essential public health tool in reducing CRE in healthcare facilities. A national intervention in Israeli long-term care facilities led to a 50% decline in incidence of acquisition of carbapenem-resistant Enterobacteriaceae (CRE) over 7 years. CRE prevalence in post-acute care hospitals decreased from 12.3% to 0.8% from 2008 to 2015.