1611. Hospital Surveillance for Carbapenemase-Producing Organisms in the Wake of an Outbreak
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: From 6/2011 through 12/2011, a cluster of carbapenem-resistant Klebsiella infections and colonization occurred in the NIH Clinical Center. Following the cluster, the hospital continued monitoring its highly immunocompromised patient population for carbapenem-resistant Enterobacteriaceae (CRE) using active surveillance and periodic environmental sampling.

Methods: From 1/1/2012 through 3/2013, rectal, groin, and throat swabs were collected on admission and twice weekly in the ICU and another high-risk unit. Rectal swabs were collected from patients who were transferred from other institutions or transferred out of the ICU, and monthly on medical-surgical inpatients. Most swabs were plated on KPC Chromagar (Hardy Diagnostics) and incubated at 35C for 18-24 hours; some were tested directly by KPC PCR. Numerous environmental surfaces were cultured. Suspicious colonies were identified by MALDI-TOF mass spectrometry and analyzed using modified Hodge test and KPC PCR. To compare KPC-carrying strains, we performed Rep-PCR, pulsed field gel electrophoresis, and whole-genome sequencing. All CRE-colonized patients were isolated and cohorted in a single area with dedicated nursing and 24-hour adherence monitoring. Equipment and rooms were disinfected with bleach, hydrogen peroxide vapor, and/or ultraviolet light.

Results: We collected 10,989 surveillance swabs from 1,705 patients, representing compliance with only 2/3 of surveillance swab orders; 98.25% of swabs were cultured and 1.75% were tested directly by KPC PCR. Among 4 newly identified CRE patients, 1 acquired the cluster strain and 3 had unrelated isolates, likely acquired at other facilities. Among 271 environmental samples, 12 (4.4%) grew CRE (9 sink drains, 1 faucet aerator, 1 handrail, and 1 medication room surfaces). All but one environmental isolate was linked to a colonized patient.

Conclusion: Stringent infection control measures and close monitoring of patients and the hospital environment have likely helped limit CRE transmission. We are improving patient compliance with active surveillance culturing through staff and patient education. Contaminated sinks are a potential reservoir and, once documented, should be addressed on an ongoing basis.

Robin T. Odom, M.S.1, Amanda M. Ramsburg, R.N.1, Angela V. Michelin, M.P.H.1, Mary Ann Bordner, M.S.1, Anna F. Lau, Ph.D.2, David K. Henderson, MD3 and Tara N. Palmore, MD4, (1)Hospital Epidemiology Service, National Institutes of Health Clinical Center, NIH, Bethesda, MD, (2)Microbiology Service, National Institutes of Health, Bethesda, MD, (3)National Institutes of Health Clinical Center, NIH, Bethesda, MD, (4)National Institutes of Health Clinical Center and Niaid, NIH, Bethesda, MD


R. T. Odom, None

A. M. Ramsburg, None

A. V. Michelin, None

M. A. Bordner, None

A. F. Lau, None

D. K. Henderson, None

T. N. Palmore, None

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