1616. Carbapenem-Resistant Klebsiella pneumoniae Cluster in a Long-term Skilled Nursing Facility Highlights the Role of Local Public Health in Prevention and Control
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • ID Week 2013 Poster_CRE.pdf (233.6 kB)
  • Background: The Philadelphia Department of Public Health (PDPH) was informed by a Hospital Infection Preventionist (IP) on October 16, 2012 of a cluster of four patients with Carbapenem-resistant Klebsiella pneumoniae (CRKP) at a 180-bed long-term skilled nursing facility (SNF). We sought to characterize the outbreak, implement infection control measures, and identify educational needs for CRKP prevention in SNFs.

    Methods: A case was defined as a CRKP isolate collected from a patient in the SNF or within 48 hours of hospitalization. Observational surveys and two point prevalence surveys were conducted to assess infection control compliance and identify colonized patients. Resistance mechanism and PFGE testing on isolates were performed. A survey was administered to assess knowledge prior to in-servicing all building staff.

    Results: Eight cases were detected from 10/16/2012 – 1/15/2013 throughout the facility. Median age of case-patients was 74.5 years (range: 65-91 years); all had underlying conditions. Infections included urinary tract infection (UTI) (n=3), UTI and septicemia (n=2), and pneumonia (n=2); point prevalence surveys detected one colonized case. The four submitted outbreak isolates were Klebsiella pneumoniae carbapenemase producers and had identical pulsed-field gel electrophoresis patterns. During the initial site visit, patients with positive CRKP infections were not on contact precautions and staff did not have knowledge of CRE or how it was transmitted. Deficiencies in hand hygiene and contact precautions were detected during the observational survey. Surveys completed by staff (n=80) showed a deficit in knowledge about transmission-based precautions, particularly among nursing assistants compared to nurses (p=0.01).

    Conclusion: This outbreak in a SNF was most likely sustained due to lack of knowledge about CRE and problems implementing and adhering to MDRO interventions, highlighting the need for CRE education and challenges with contact precaution use in the long-term setting. Expanding the local health department role, PDPH plans to take a community perspective for prevention and control that includes characterizing burden, enhancing communication between facilities, and educating SNFs in an area where CRE is known to be prevalent.

    Jennifer Sears, BS, MPH, Acute Communicable Disease, Philadelphia Department of Public Health, Philadelphia, PA and Ami S. Patel, PhD, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Philadelphia, PA; Philadelphia Department of Public Health, Philadelphia, PA


    J. Sears, None

    A. S. Patel, None

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