Institutional Control Measures to Curtail the Epidemic Spread of Carbapenem-Resistant Klebsiella pneumoniae: A 4-Year Perspective
| Autor: | Phillip D. Levin, Yuval Weiss, Ilana Gross, Colin Block, Carmela Schwartz, Shmuel Benenson, Allon E. Moses, Matan J. Cohen |
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| Rok vydání: | 2011 |
| Předmět: |
Microbiology (medical)
Pediatrics medicine.medical_specialty Nursing staff Isolation (health care) Epidemiology Carbapenem resistant Klebsiella pneumoniae Psychological intervention Tertiary care beta-Lactam Resistance law.invention Hospitals University Patient Isolation law Epidemic spread Humans Medicine Prospective Studies Israel Epidemics Cross Infection Infection Control business.industry Emergency department Intensive care unit Anti-Bacterial Agents Klebsiella Infections Klebsiella pneumoniae Infectious Diseases Carbapenems Population Surveillance Carrier State Emergency medicine business |
| Zdroj: | Infection Control & Hospital Epidemiology. 32:673-678 |
| ISSN: | 1559-6834 0899-823X 0195-9417 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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