Institutional Control Measures to Curtail the Epidemic Spread of Carbapenem-Resistant Klebsiella pneumoniae: A 4-Year Perspective

• Published in: Infection control and hospital epidemiology 2011-07, Vol.32 (7), p.673-678
• Main Authors: Cohen, Matan J., Block, Colin, Levin, Phillip D., Schwartz, Carmela, Gross, Ilana, Weiss, Yuval, Moses, Allon E., Benenson, Shmuel
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - pharmacology; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; beta-Lactam Resistance; Biological and medical sciences; Carbapenems - pharmacology; Carrier State; Cross Infection - epidemiology; Cross Infection - prevention & control; Emergency departments; Epidemics; Epidemics - prevention & control; Hospital admissions; Hospital beds; Hospitals, University; Humans; Infection control; Infection Control - methods; Infections; Intensive care units; Israel; Klebsiella Infections - epidemiology; Klebsiella Infections - prevention & control; Klebsiella pneumoniae; Klebsiella pneumoniae - drug effects; Klebsiella pneumoniae - isolation & purification; Medical sciences; Miscellaneous; Nursing; Original Article; Patient compliance; Patient Isolation; Patient surveillance; Pharmacology. Drug treatments; Population Surveillance; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1086/660358

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 ( ). 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 ( ). 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.