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628 Institutional Control Measures to Curtail Carbapenem-Resistant Klebsiella pneumoniae

Sunday, April 3, 2011: 2:30 PM
Coronado A (Hilton Anatole)
Matan J. Cohen , Hadassah – Hebrew University Medical Center, Jerusalem, Israel
Colin Block, MD , Hadassah-Hebrew University Medical Center, Jerusalem, Israel
Phillip D. Levin , Hadassah – Hebrew University Medical Center, Jerusalem, Israel
Carmela Schwartz, RN , Hadassah – Hebrew University Medical Center, Jerusalem, Israel
Ilana Gross , Hadassah – Hebrew University Medical Center, Jerusalem, Israel
Yuval Weiss , Hadassah – Hebrew University Medical Center, Jerusalem, Israel
Allon E. Moses , Hadassah – Hebrew University Medical Center, Jerusalem, Israel
Shmuel Benenson, MD , Department of Clinical Microbiology and Infectious Diseases, Hadassah – Hebrew University Medical Center, Jerusalem, Israel
Background: In late 2005 a national epidemic of nosocomial carbapenem resistant Klebsiella pneumoniae (CRKP) infections emerged in Israel. Infection or colonization with CRKP has been associated with high mortality rate. Different strategies have been applied in an attempt to control the outbreak.

Objective: To describe the implementation of an institution wide - multistep intervention in order to curtail an epidemic of CRKP.

Methods: This Hospital wide intervention and follow-up took place at the Hadassah – Hebrew University Medical Center, a 775 beds tertiary hospital in Jerusalem, Israel.

The effect of four interventions was assessed. (1) From March 2006, a policy of isolation for CRKP colonized/infected patients in single rooms was established. (2) Cohorting of CRKP patients with dedicated nursing staff and screening of patients neighboring a new CRKP patient was started in March 2007. (3) Weekly active surveillance of ICU patients and (4) selective surveillance of Emergency Department admissions were implemented during August 2008 and March 2009, respectively. Interrupted regression analysis and change-point analysis were used to assess the effect of each intervention on the CRKP epidemic.

Results: Patient cohorting lead to a steep decline in CRKP incidence from 35 to 13 new infections per 1000 beds per month (p<0.001). Active surveillance interventions were followed by a decrease in the incidence of CRKP in clinical cultures, and an incidence in detection of CRKP from screening cultures. The prevalence rates dropped significantly once cohorting began (p<0.001) and again during August 2009.

Conclusions: Patient cohorting with dedicated staff combined with focused active surveillance effectively terminated the CRKP epidemic. Cohorting reduced cross infection within the hospital, while active surveillance allowed for earlier detection of carrier status. Both interventions should be considered in attempts to contain a hospital epidemic.