1209. Effect of a Bundled Intervention on Infection and Colonization due to Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae (KPC) at 4 Long-Term Acute Care Hospitals (LTACHs) in Chicago
Session: Oral Abstract Session: Identifying and Overcoming Challenges in Preventing Transmission of MDRO GNR Bacterial Infections in Healthcare Settings
Saturday, October 5, 2013: 9:00 AM
Room: The Moscone Center: 250-262

Background: KPC are an increasing threat in healthcare institutions.  LTACHs may have especially high rates of KPC.  We present preliminary results of an intervention to control KPC spread in LTACHs.

Methods:  We conducted a study of the effect of a bundled intervention on KPC infection and colonization at 4 LTACHs in Chicago.  Sites were randomly selected to enter the study in a step-wise fashion, 1 LTACH every 2 months from November 2011 to July 2012. The intervention, based on evaluation of modes of KPC transmission, comprised admission and biweekly rectal screening of patients for KPC-carriage, bathing all patients daily with 2% chlorhexidine cloths, separation of KPC-positive patients on dedicated floors (cohorts) or in private rooms, education on KPC, and a hand hygiene improvement campaign; environmental cleaning was not targeted. We used the following objective outcomes adapted from National Healthcare Safety Network's MDRO module (Lab-ID or blood event, hospital-onset): Carbapenem-resistant Enterobacteriaceae (CRE)-Klebsiella from any clinical culture; CRE-Klebsiella from blood culture; any pathogen from blood culture.  Data were extracted from a central laboratory data base.  Analysis was conducted using a general linear model approach, adjusting for site effects and confounding by secular trends.

Results:  Pre-intervention periods for each LTACH ranged from 21-27 months; intervention periods ranged from 5-12 months.  Compared to pre-intervention periods, significant declines in mean rates of all outcomes were observed in intervention periods (Table). 

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During the intervention, mean KPC rectal colonization rates declined significantly (prevalence, 45% to 32%, p<0.001; incidence, 4.2 to 2.2 KPC acquisitions/100 at-risk patient weeks, p=0.007).  Reductions in colonization rates were seen at 3 LTACHs; rates at the 4th LTACH were stable. 

Conclusion:  An intervention bundle was successful in reducing mean rates of CRE-Klebsiella from any clinical culture, CRE-Klebsiella from blood cultures, and any pathogen from blood cultures at 4 LTACHs in Chicago.  Prevalence and incidence of KPC rectal colonization also declined.  Additional work is needed to determine which bundle components are necessary and sufficient for timely control of KPC spread.

Mary K Hayden, MD, FSHEA, FIDSA1, Michael Y. Lin, MD, MPH1, Rosie D. Lyles-Banks, MD, MHA2, Shayna Weiner, MPH1, Nicholas Moore, MS, MLS(ASCP)1, Karen Lolans, BS1, Huiyuan Zhang, MS2, Louis Fogg, PhD1, Donald Blom, RN, BA1, Caroline Thurlow, MD1, Monica Sikka, MD1, David W. Hines, MD3, Robert A Weinstein, MD, FIDSA1 and for The CDC Prevention Epicenters Program4, (1)Rush University Medical Center, Chicago, IL, (2)Cook County Health and Hospitals System, Chicago, IL, (3)Metro Infectious Disease Consultants, LLC, Hinsdale, IL, (4)cdc, Atlanta, GA

Disclosures:

M. K. Hayden, Sage, Inc.: ,

M. Y. Lin, None

R. D. Lyles-Banks, None

S. Weiner, None

N. Moore, None

K. Lolans, None

H. Zhang, None

L. Fogg, None

D. Blom, None

C. Thurlow, None

M. Sikka, None

D. W. Hines, None

R. A. Weinstein, None

F. T. CDC Prevention Epicenters Program, None

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