Emergence of Carbapenem-Resistant Enterobacteriaceae (CRE) in Orange County, CA and Support for Regional Strategies to Limit Spread
Background: The spread of CRE from eastern to western United States has enabled the study of its emergence in California (CA). We evaluated CRE emergence in Orange County (OC), CA hospitals serving 3.1 million residents and evaluated regional support of infection prevention (IP) programs for containment strategies.
Methods: We conducted a survey (14 questions, 3 data tables) of the 31 hospital IP programs in OC. Questions assessed willingness to adopt strategies to address CRE with responses of “definitely” or “possibly” deemed supportive. Data tables were used to determine the frequency of culture positive CRE patients from 2008-2013.
Results: To date, 14 (52%) IP programs representing 16 hospitals completed the survey (still ongoing). CRE was first detected in 2010 in 12.5% of respondent hospitals. By 2013, 56.3% of hospitals reported CRE cases (Figure). 100% of respondents supported some form of regional collaboration to implement a CRE prevention “bundle”. Regarding specific strategies, 100% supported single room and contact precautions for CRE+ patients and 12.5% had already enacted this. 100% supported active communication regarding CRE+ status with facilities accepting their patients. 92.8% supported periodic active surveillance of hand hygiene and contact precautions for CRE+ patient rooms. 85.7% supported daily chlorhexidine bathing of CRE+ patients (14.3% uncertain), and 12.5% were currently bathing. 64.3% supported (14.3% uncertain, 21.4% against) annual point prevalence screening for CRE in high risk units or patients (e.g. patients admitted from long term care facilities). While 78.6% supported screening roommates of CRE+ patients, only 42.9% supported screening neighboring rooms.
Conclusion: The swift rise in CRE cases in OC parallels epidemiology seen in other areas where CRE is now endemic. However in OC, CRE is still concentrated in only a few facilities and concerted regional intervention may prevent CRE from becoming endemic. Responding IP programs fully supported regional strategies involving isolating CRE+ patients and relaying positivity to transferring facilities. However compliance assessment, screening, and decolonization were less well supported and likely influenced by resource and financial requirements.
S. K. Gohil,
A. Gombosev, None
M. Zahn, None
M. Cheung, None
J. Chang, None
S. S. Huang, None
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