Infection Control Halved Carbapenem-Resistant Klebsiella Transmission

BOSTON – A nationwide coordinated infection-control plan focusing on the prevention of carbapenem-resistant Klebsiella pneumoniae infections in long-term care facilities resulted in a 50% decrease in the risk of K. pneumoniae acquisitions detected by clinical culture, Israeli investigators reported at the annual interscience conference on antimicrobial agents and chemotherapy.

The total incidence of new acquisitions detected by clinical culture declined from 5.2 per 1,000 beds in 2008 to 2.4 per 1,000 beds in 2010, a statistically significant difference. The program also reduced significantly the overall prevalence of infections in all postacute care facilities in Israel, from 12.0% in 2008 to 8.3% in 2010, said Dr. Debby Ben-David of the National Center for Infection Control in Tel Aviv.

“We found a significant burden of carbapenem-resistant K. pneumoniae carriage in postacute care facilities. A national intervention that included general upgrading of infection-control resources, in addition to specific guidelines focusing on the prevention of Klebsiella pneumonia, results in decreased rates of infection,” Dr. Ben-David said at the meeting, which was sponsored by the American Society for Microbiology.

In response to a 2006 outbreak of carbapenem-resistant K. pneumoniae (CRKP) in Israeli health care facilities, health authorities instituted an infection-control program in 2007 involving all 13 postacute care facilities (with 2,913 total beds) in the nation. The goal of the intervention was to prevent the spread of CRKP in facilities housing patients with complex medical problems who are usually transferred from acute care facilities after prolonged hospitalizations.

The target facilities care for a heterogeneous population, including patients requiring skilled nursing care, chronic mechanical ventilation, subacute care, or rehabilitation services, Dr. Ben-David noted.

The intervention consisted of mandatory weekly reports to a national coordinator, including data on transfers from other facilities, new acquisitions of CRKP (at least 72 hours after admission), screening and clinical evaluation, and total prevalence. Site visits were conducted in 2008 and 2010, and facilities were scored on 15 elements of infection control to measure compliance, she said.

Centers also performed cross-sectional prevalence surveys with representative samples of wards in each institution, collection of rectal swabs, and attention to risk factors such as skilled-nursing unit stay and sharing a room with a known CRKP carrier.

The program designers also developed and promulgated guidelines targeted to specific populations. For example, guidelines created for skilled care, ventilation, and subacute wards call for admission rectal screening, contact precautions, and single rooms or cohorting of infected patients. Guidelines for rehabilitation wards are less stringent, including modifying contact precautions and allowing room-sharing of colonized and noncolonized patients.

The investigators compared rates during two periods: January 2008 to February 2009, and March 2009 to July 2010. They found that the mean 15-point infection-control score improved from 6.7 in 2008 to 10.9 in 2010, with most of the gains being made in the areas of admissions and contact screenings, Dr. Ben-David reported.

They also looked at 1,385 patients known to be colonized with CRKP who were transferred from acute care to postacute care facilities and 846 who acquired CRKP during a postacute care stay.

The average number of transferred carriers per month did not differ significantly from 2008 (16.4 per 1,000 beds) to 2010 (17.4 per 1,000 beds), but the average number of carriers identified by active screening on admission each month nearly doubled, from 2.4 per 1,000 to 4.2 per 1,000, a significant difference.

The percentage of patients identified by screening jumped from 36.2% in 2008 to 68.9% in 2010, while the total incidence of acquisitions declined significantly, from 11.8 per 1,000 to 9.9 per 1,000.

“These results should encourage interventions in postacute care facilities to reduce the burden of antibiotic-resistant organisms,” Dr. Ben-David said.

The study was funded by the Israeli government. Neither Dr. Ben-David nor any of her coauthors had financial disclosures.

BOSTON – A nationwide coordinated infection-control plan focusing on the prevention of carbapenem-resistant Klebsiella pneumoniae infections in long-term care facilities resulted in a 50% decrease in the risk of K. pneumoniae acquisitions detected by clinical culture, Israeli investigators reported at the annual interscience conference on antimicrobial agents and chemotherapy.

The total incidence of new acquisitions detected by clinical culture declined from 5.2 per 1,000 beds in 2008 to 2.4 per 1,000 beds in 2010, a statistically significant difference. The program also reduced significantly the overall prevalence of infections in all postacute care facilities in Israel, from 12.0% in 2008 to 8.3% in 2010, said Dr. Debby Ben-David of the National Center for Infection Control in Tel Aviv.

“We found a significant burden of carbapenem-resistant K. pneumoniae carriage in postacute care facilities. A national intervention that included general upgrading of infection-control resources, in addition to specific guidelines focusing on the prevention of Klebsiella pneumonia, results in decreased rates of infection,” Dr. Ben-David said at the meeting, which was sponsored by the American Society for Microbiology.

In response to a 2006 outbreak of carbapenem-resistant K. pneumoniae (CRKP) in Israeli health care facilities, health authorities instituted an infection-control program in 2007 involving all 13 postacute care facilities (with 2,913 total beds) in the nation. The goal of the intervention was to prevent the spread of CRKP in facilities housing patients with complex medical problems who are usually transferred from acute care facilities after prolonged hospitalizations.

The target facilities care for a heterogeneous population, including patients requiring skilled nursing care, chronic mechanical ventilation, subacute care, or rehabilitation services, Dr. Ben-David noted.

The intervention consisted of mandatory weekly reports to a national coordinator, including data on transfers from other facilities, new acquisitions of CRKP (at least 72 hours after admission), screening and clinical evaluation, and total prevalence. Site visits were conducted in 2008 and 2010, and facilities were scored on 15 elements of infection control to measure compliance, she said.

Centers also performed cross-sectional prevalence surveys with representative samples of wards in each institution, collection of rectal swabs, and attention to risk factors such as skilled-nursing unit stay and sharing a room with a known CRKP carrier.

The program designers also developed and promulgated guidelines targeted to specific populations. For example, guidelines created for skilled care, ventilation, and subacute wards call for admission rectal screening, contact precautions, and single rooms or cohorting of infected patients. Guidelines for rehabilitation wards are less stringent, including modifying contact precautions and allowing room-sharing of colonized and noncolonized patients.

The investigators compared rates during two periods: January 2008 to February 2009, and March 2009 to July 2010. They found that the mean 15-point infection-control score improved from 6.7 in 2008 to 10.9 in 2010, with most of the gains being made in the areas of admissions and contact screenings, Dr. Ben-David reported.

They also looked at 1,385 patients known to be colonized with CRKP who were transferred from acute care to postacute care facilities and 846 who acquired CRKP during a postacute care stay.

The average number of transferred carriers per month did not differ significantly from 2008 (16.4 per 1,000 beds) to 2010 (17.4 per 1,000 beds), but the average number of carriers identified by active screening on admission each month nearly doubled, from 2.4 per 1,000 to 4.2 per 1,000, a significant difference.

The percentage of patients identified by screening jumped from 36.2% in 2008 to 68.9% in 2010, while the total incidence of acquisitions declined significantly, from 11.8 per 1,000 to 9.9 per 1,000.

“These results should encourage interventions in postacute care facilities to reduce the burden of antibiotic-resistant organisms,” Dr. Ben-David said.

The study was funded by the Israeli government. Neither Dr. Ben-David nor any of her coauthors had financial disclosures.

BOSTON – A nationwide coordinated infection-control plan focusing on the prevention of carbapenem-resistant Klebsiella pneumoniae infections in long-term care facilities resulted in a 50% decrease in the risk of K. pneumoniae acquisitions detected by clinical culture, Israeli investigators reported at the annual interscience conference on antimicrobial agents and chemotherapy.

The total incidence of new acquisitions detected by clinical culture declined from 5.2 per 1,000 beds in 2008 to 2.4 per 1,000 beds in 2010, a statistically significant difference. The program also reduced significantly the overall prevalence of infections in all postacute care facilities in Israel, from 12.0% in 2008 to 8.3% in 2010, said Dr. Debby Ben-David of the National Center for Infection Control in Tel Aviv.

“We found a significant burden of carbapenem-resistant K. pneumoniae carriage in postacute care facilities. A national intervention that included general upgrading of infection-control resources, in addition to specific guidelines focusing on the prevention of Klebsiella pneumonia, results in decreased rates of infection,” Dr. Ben-David said at the meeting, which was sponsored by the American Society for Microbiology.

In response to a 2006 outbreak of carbapenem-resistant K. pneumoniae (CRKP) in Israeli health care facilities, health authorities instituted an infection-control program in 2007 involving all 13 postacute care facilities (with 2,913 total beds) in the nation. The goal of the intervention was to prevent the spread of CRKP in facilities housing patients with complex medical problems who are usually transferred from acute care facilities after prolonged hospitalizations.

The target facilities care for a heterogeneous population, including patients requiring skilled nursing care, chronic mechanical ventilation, subacute care, or rehabilitation services, Dr. Ben-David noted.

The intervention consisted of mandatory weekly reports to a national coordinator, including data on transfers from other facilities, new acquisitions of CRKP (at least 72 hours after admission), screening and clinical evaluation, and total prevalence. Site visits were conducted in 2008 and 2010, and facilities were scored on 15 elements of infection control to measure compliance, she said.

Centers also performed cross-sectional prevalence surveys with representative samples of wards in each institution, collection of rectal swabs, and attention to risk factors such as skilled-nursing unit stay and sharing a room with a known CRKP carrier.

The program designers also developed and promulgated guidelines targeted to specific populations. For example, guidelines created for skilled care, ventilation, and subacute wards call for admission rectal screening, contact precautions, and single rooms or cohorting of infected patients. Guidelines for rehabilitation wards are less stringent, including modifying contact precautions and allowing room-sharing of colonized and noncolonized patients.

The investigators compared rates during two periods: January 2008 to February 2009, and March 2009 to July 2010. They found that the mean 15-point infection-control score improved from 6.7 in 2008 to 10.9 in 2010, with most of the gains being made in the areas of admissions and contact screenings, Dr. Ben-David reported.

They also looked at 1,385 patients known to be colonized with CRKP who were transferred from acute care to postacute care facilities and 846 who acquired CRKP during a postacute care stay.

The average number of transferred carriers per month did not differ significantly from 2008 (16.4 per 1,000 beds) to 2010 (17.4 per 1,000 beds), but the average number of carriers identified by active screening on admission each month nearly doubled, from 2.4 per 1,000 to 4.2 per 1,000, a significant difference.

The percentage of patients identified by screening jumped from 36.2% in 2008 to 68.9% in 2010, while the total incidence of acquisitions declined significantly, from 11.8 per 1,000 to 9.9 per 1,000.

“These results should encourage interventions in postacute care facilities to reduce the burden of antibiotic-resistant organisms,” Dr. Ben-David said.

The study was funded by the Israeli government. Neither Dr. Ben-David nor any of her coauthors had financial disclosures.