333. Impact of expanded Carbapenem Resistant Enterobacteriacae (CRE) screening on Rates of Hospital Acquired (HA) CRE infection
Session: Poster Abstract Session: HAI: Multi Drug Resistant Gram Negatives
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • CRE_ID_WEEK poster.pdf (138.4 kB)
  • Background: Unrecognized patients colonized with Carbapenem Resistant Enterobacteriacae (CRE) serve as a reservoir for transmission. Surveillance for CRE allows earlier identification and isolation. We evaluated two different screening approaches on rates of HA CRE infections. January 2013 through July 2015, we began limited CRE surveillance by performing point prevalence on 2-3 units per week on a rotating basis. In August 2015 thru April 2016, surveillance for CRE was expanded to include on admission and weekly screening in high risk units (Intensive Care Unit, bone marrow/liver transplant, cohort units and hepatobiliary surgical unit), as well as on admission screening of patients with a recent hospital stay or transferred in from another facility. Patients identified with CRE were placed on contact isolation, cohorted with dedicated nursing staff and received chlorhexidine baths daily.

    Methods: Patients admitted throughout all time periods were monitored for development of CRE infection. Rates of CRE colonization and hospital acquired infection were compared between the limited surveillance and expanded surveillance periods.

    Results: There was no statistically significant difference in the overall rate of CRE colonized patients identified by the two screening approaches (18 per 1000 patients screened in the limited surveillance period vs 22 per 1000 in the expanded screening period, p = 0.07). The number of patients with CRE identified on admission increased significantly from 2 per 1000 screened in the limited surveillance period to 9 per 1000 screened (p<0.001) in the expanded surveillance period. HA CRE infections decreased from 1.1 per 10000 patient days with limited surveillance to 0.8 per 10,000 patient days in the expanded surveillance though the difference was not statistically significant. The rate of progression from colonization to infection decreased by 80% with the expanded program (p<0.05).

    Conclusion:  With expansion of a CRE screening program, we significantly increased our ability to identify patients with CRE on admission allowing for earlier isolation, cohorting of nursing staff, and CHG bathing and less progression to infection.

    Catherine Passaretti, MD, Medicine, Carolinas Medical Center, Charlotte, NC, Anupama Neelakanta, MD, Department of Infectious Diseases, Carolinas Healthcare System, Charlotte, NC, Monica Schmidt, MPH, PhD, Dickson Advanced Analytics, Carolinas Healthcare System, Charlotte, NC and Joanne Sitaras, BSN, Infection Prevention, Carolinas Healthcare System, Parma, OH

    Disclosures:

    C. Passaretti, None

    A. Neelakanta, None

    M. Schmidt, None

    J. Sitaras, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.