1409. Use of Novel Environmental Interventions to Control a Multi-Year Carbapenem-Resistant Enterobacteriaceae Outbreak in the ICU Setting
Session: Poster Abstract Session: Epidemiology of Multiple Drug-Resistant Gram Negative Rods
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H

Background:   Carbapenem-resistant Enterobacteriaceae (CRE) can become endemic despite standard infection control practices.  We describe an outbreak of CRE in a 651 bed medical center with three contiguous critical care units.


Methods: Cases were classified as outbreak-related if the culture was collected >48 hours after admission and was blaKPC PCR positive.  Traditional infection control measures were emphasized.  Bi-monthly point prevalence cultures (perianal, sputum, wound) began 2/08.  Vaporized hydrogen peroxide (VHP) room decontamination began 1/10.  Drain testing and treatment with bleach began 6/10 and daily chlorhexidine gluconate (CHG) baths were started 2/11.  Hydrogen peroxide foam was used instead of bleach beginning 10/11.  PFGE strain typing was conducted on clinical and environmental isolates in 2010. 


Results:   In 2007 an increase in CRE was identified in the critical care units.  The incidence rate rose from 0.34 per 1000 patient days in 2006 to 1.12 in 2007.  Standard infection control practices were reinforced:  hand hygiene, contact precautions, and enhanced disinfection of patient equipment and high-touch surfaces.  No effect on CRE incidence was seen from the above measures, patient surveillance cultures or VHP.  Rates for these units remained elevated from 2008 – 2010 (1.81, 2.31, and 2.14). 

In 6/10, 20 room sinks were cultured and 50% of cultures were positive for CRE.  Despite daily drain disinfection, the rate did not decrease until CHG baths were implemented in 2/11.  For the 8-month period both interventions were in place the rate fell to 0.14.  From 10/11 to 1/12 drain disinfection was reduced to 2-3 times per week and the product was changed (baths continued) and the rate increased to 1.19.  Daily drain treatment was then reinstituted and the incidence fell to 0.30.

Strain type matches were noted between clinical and environmental isolates, reinforcing the role of the environment in the persistence of the outbreak.

Conclusion:   This outbreak involved 132 patients, 118 (89.39%) were associated with the outbreak units.  Traditional infection control strategies were not adequate to control the outbreak.   Our results suggest that creative interventions targeting both the environment and the patient may be necessary to reduce the incidence of CRE.



Michelle T. Kaiser, CIC1, Sarah L. Elmendorf, MD1, Donna L. Kent, RN, CIC1 and Susan M. Harrington, PhD2, (1)Epidemiology, Albany Medical Center, Albany, NY, (2)Microbiology, Cleveland Clinic, Cleveland, OH


M. T. Kaiser, None

S. L. Elmendorf, None

D. L. Kent, None

S. M. Harrington, None

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