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Clin Infect Dis. Managing Transmission of Carbapenem-Resistant Enterobacteriaceae in Healthcare Settings: A View From the Trenches
[Source: Clinical Infectious Diseases, full page: (LINK). Abstract, edited.]
Managing Transmission of Carbapenem-Resistant Enterobacteriaceae in Healthcare Settings: A View From the Trenches
Robert A. Weinstein, Section Editor, Tara N. Palmore and David K. Henderson
Author Affiliations: Hospital Epidemiology Service and the Office of the Deputy Director for Clinical Care, Clinical Center, National Institutes of Health, Bethesda, Maryland
Correspondence: David K. Henderson, MD, National Institutes of Health Clinical Center, 10 Center Drive, Bldg 10, Rm 6-1480, Bethesda, MD 20892 (dkh@nih.gov).
Abstract
In 2011, the National Institutes of Health Clinical Center experienced a cluster of infection and colonization caused by carbapenem-resistant Klebsiella pneumoniae among profoundly immunocompromised inpatients. This manuscript describes the approach and interventions that were implemented in an attempt to curtail the cluster. Interventions employed included engagement of all stakeholders involved in care of at-risk patients; detailed and frequent communication with hospital staff about issues relating to the outbreak; aggressive microbial surveillance; use of techniques that facilitate rapid identification of resistant organisms; rapid characterization of resistance mechanisms; whole-genome sequencing of outbreak isolates to characterize the spread and to investigate mechanisms of healthcare-associated spread; implementation of enhanced contact precautions for all infected or colonized patients; geographic and personnel cohorting; daily chlorhexidine gluconate baths; dedicating equipment to be used solely for cohorted patients and aggressive decontamination of equipment that had to be reused on uncohorted patients; monitoring adherence to infection control precautions, including unwavering attention to adherence to appropriate hand hygiene procedures; and attention to the details of environmental decontamination. In addition, the manuscript discusses some of the challenges associated with managing such an event, as well as a few of the unanticipated consequences associated with the aftermath of the case cluster.
Key words
carbapenemase - carbapenem-resistant enterobacteriaceae - whole genome sequencing ? isolation ? transmission - multi-drug resistance
Received May 17, 2013. Accepted August 1, 2013.
Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2013. This work is written by (a) US Government employee(s) and is in the public domain in the US.
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Managing Transmission of Carbapenem-Resistant Enterobacteriaceae in Healthcare Settings: A View From the Trenches
Robert A. Weinstein, Section Editor, Tara N. Palmore and David K. Henderson
Author Affiliations: Hospital Epidemiology Service and the Office of the Deputy Director for Clinical Care, Clinical Center, National Institutes of Health, Bethesda, Maryland
Correspondence: David K. Henderson, MD, National Institutes of Health Clinical Center, 10 Center Drive, Bldg 10, Rm 6-1480, Bethesda, MD 20892 (dkh@nih.gov).
Abstract
In 2011, the National Institutes of Health Clinical Center experienced a cluster of infection and colonization caused by carbapenem-resistant Klebsiella pneumoniae among profoundly immunocompromised inpatients. This manuscript describes the approach and interventions that were implemented in an attempt to curtail the cluster. Interventions employed included engagement of all stakeholders involved in care of at-risk patients; detailed and frequent communication with hospital staff about issues relating to the outbreak; aggressive microbial surveillance; use of techniques that facilitate rapid identification of resistant organisms; rapid characterization of resistance mechanisms; whole-genome sequencing of outbreak isolates to characterize the spread and to investigate mechanisms of healthcare-associated spread; implementation of enhanced contact precautions for all infected or colonized patients; geographic and personnel cohorting; daily chlorhexidine gluconate baths; dedicating equipment to be used solely for cohorted patients and aggressive decontamination of equipment that had to be reused on uncohorted patients; monitoring adherence to infection control precautions, including unwavering attention to adherence to appropriate hand hygiene procedures; and attention to the details of environmental decontamination. In addition, the manuscript discusses some of the challenges associated with managing such an event, as well as a few of the unanticipated consequences associated with the aftermath of the case cluster.
Key words
carbapenemase - carbapenem-resistant enterobacteriaceae - whole genome sequencing ? isolation ? transmission - multi-drug resistance
Received May 17, 2013. Accepted August 1, 2013.
Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2013. This work is written by (a) US Government employee(s) and is in the public domain in the US.
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