Program Schedule

Present State of CRE Prevention:  What are U.S. Hospitals Doing?

Session: Poster Abstract Session: Multidrug-resistant Organisms: Epidemiology and Prevention
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • ID Week 2014 CRE_Final.pdf (929.8 kB)
  • Background: Carbapenem-resistant Enterobacteriaceae (CRE) have emerged as an immediate threat to hospitalized patients.  With limited guidance from the Centers for Disease Control and Prevention (CDC), clinicians often employ interventions recommended for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE):  hand hygiene, contact precautions (CP), environmental disinfection.  Some hospitals use targeted active surveillance testing (AST).  This study was conducted to assess the present state of interventions to reduce transmission of CRE in U.S. hospitals.

    Methods: 751 physician members of the Emerging Infections Network (EIN) who had identified themselves as having interest or involvement in infection prevention were invited to complete an electronic survey.  The survey contained 8 questions designed to ascertain current practices related to reducing transmission of CRE. 

    Results: 429 members responded to the survey (57.7%). 97% reported using CP for CRE.  The most widely used trigger for CP was positive clinical culture (97%), followed by pre-existing alert in the electronic record (75%). Practices for discontinuation of CP varied: 38% reported using CP indefinitely once a patient becomes positive; 43% use CP until a patient is cleared, 13% use CP for the specific encounter only and 10% use CP for one year post- positive culture.  18% reported performing CRE AST for a subset of inpatients. Adjunct measures to reduce the risk of transmission such as CHG bathing for any inpatient population and room disinfection using hydrogen peroxide vapor or UVC light were reported to be used by 85% and 23%, respectively.

    Conclusion: 97% of respondents use routine CP for CRE; however, practices for the duration of CP are heterogeneous.  Though not based upon guidance from CDC, a clearance process for CRE, which results in discontinuation of CP, was used by 43% of respondents.  Horizontal interventions such as CHG bathing and UVC light disinfection, while commonly used, are of questionable utility for reducing the risk of CRE transmission. Evidence-based guidelines from professional organizations regarding measures to reducing transmission of CRE are needed.

    Dana Russell, MPH1, Susan E. Beekmann, RN, MPH2, Philip M. Polgreen, MD2, Zachary Rubin, MD3 and Daniel Z. Uslan, MD, MS3, (1)Clinical Epidemiology and Infection Prevention, UCLA Health, Los Angeles, CA, (2)Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, (3)Infectious Diseases, David Geffen School of Medicine/University of California, Los Angeles, Los Angeles, CA


    D. Russell, None

    S. E. Beekmann, None

    P. M. Polgreen, None

    Z. Rubin, None

    D. Z. Uslan, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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