Transcript Wisconsin AST Training 2012 Presentation, G.Borlaug, Oct 2012

Division of Public Health
CRE Surveillance and Prevention of
Transmission in Healthcare Settings
Gwen Borlaug, CIC, MPH
Coordinator, Healthcare-Associated
Infections Prevention Program
WSLH AST Conference
May 10, 2012
Key premise
The laboratory is a critical partner in
preventing transmission of carbapenemresistant Enterobacteriaceae (CRE) in
healthcare settings.
Enterobacteriaceae
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Gram negative bacteria usually residing in the GI
tract
Ferment glucose
Examples
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Klebsiella spp.
E. coli
Enterobacter spp.
Serratia marcescens
Citrobacter spp.
Proteus spp.
Enterobacteriaceae
E. coli, Klebsiella spp., and Enterobacter
spp. made up 21% of all healthcareassociated infections (HAI) in 2006-07.
Hidron et al. Infect Control Hosp Epidemiol 2008;29:996-1011
CRE
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Important healthcare-associated pathogens
Resistant to almost all antimicrobial agents
Infections associated with high morbidity and
mortality
Present in US hospitals since 1999, routinely
recovered in NY and NJ hospitals
From 2000-2007, HAI data reported to CDC indicate
the percentage of CR Klebsiella isolates increased
from 1% to 8%
Sporadic cases known to occur in WI
Rationale for action
Because these organisms pose a threat to
patients in acute care settings, are difficult to
treat and cause increased mortality, cost,
and length of stay, CDC is urging state health
departments to determine prevalence and
contain these organisms before they become
endemic.
Statewide surveillance
In Wisconsin, the approach is to determine
prevalence in acute care facilities using the
National Healthcare Safety Network, to
detect patients with CRE
infections/colonization quickly through
recommended laboratory methods, and to
promptly apply strict infection control
methods.
Surveillance design
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Active surveillance for CR Klebsiella spp. and for CR
E. coli based on unique clinical isolates detected per
inpatient per month in each facility
6 months: December 1, 2011-May 31, 2012
All WI acute care, critical access, and long-term care
hospitals (n = 137)
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Includes specialty acute care such as children’s, orthopedic,
heart
Excludes behavioral, AODA, psychiatric, rehabilitation
hospitals
Findings to date
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11 reported events; 8 cases
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5 cases from same acute care facility, 4 of which
were residents of same LTC facility
5th case was a patient on same unit as a resident
from the LTC facility
PFGE analysis suggests transmission within the
LTC facility and transmission in the acute care
facility
Remaining 6 events represent 3 sporadic
cases
Preventing transmission
of CRE
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Strict contact precautions for all known
infected and colonized patients
Regional collaboration and communication
across all healthcare settings
Active surveillance testing in certain
situations
Advanced measures when needed (e.g.
cohorting of patients, staff)
Reference
Centers for Disease Control and Prevention. Guidance for
control of infections with carbapenem-resistant or
carbapenemase-producing Enterobacteriaceae in acute
care facilities. MMWR 58 (10); 256-260
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5810a4.htm
Questions
Gwen Borlaug, CIC, MPH
Division of Public Health
1 West Wilson Street Room 318
Madison, WI 53702
608-267-7711
[email protected]