Table 6

Synopsis of 11 successful infection control studies for CPE infections in nonendemic and endemic settings

ReferenceStudy designHealth care setting and geographic regionInfection control measures Outcome
BaselineAdditional
Studies in regions where CPE are not endemic
    110 Retrospective36-bed ICU in a tertiary care hospital, Melbourne, Australia1. Surveillance of culture results1. Universal contact precautions in ICUDecrease of CPE cases from 3 to 1 per month
2. Standard precautions2. Single-room isolation of CPE patients (all wards)
3. Environmental cleaning3. Restriction of carbapenem use
    122 RetrospectiveAbdominal surgery center, Paris, France1. Active surveillance for ESBLs1. Preemptive isolation of contact patients and newly admitted patientsRapid control of the outbreak
2. Isolation of CPE patients2. Dedicated nursing staff
3. Contact precautions3. Limited transfer of CPE patients
4. Environmental disinfection4. Antibiotic restriction policy (imipenem)
5. Active surveillance5. Screening campaign targeting contact patients discharged from the hospital
    43 Retrospective7 hospitals, Paris, France1. National early warning system for multiresistant isolates1. Cohorting of CPE cases and contactsRapid control of the outbreak
2. Active surveillance for ESBLs2. Flagging of CPE cases
3. Active screening of contact patients3. Dedicated health care workers
4. Evaluation of duodenoscope disinfection practices4. Reinforcing hand hygiene and contact precautions
5. Limited transfer of CPE cases and contacts
6. Revision of duodenoscope disinfection procedure
Studies in regions of endemicity
    127 Retrospective10-bed ICU in a tertiary care hospital, New York, NY1. Contact isolation of CPE patients1. Active surveillance for CPE on admission to ICU and weekly thereafterIncidence decreased from 9.7 ± 2.2 to 3.7 ± 1.6 CPE cases per 1,000 patient-days
2. Environmental cleaning2. ICU closure and disinfection
3. Infection control supervising3. Cohorting of CPE patients
4. Active surveillance for vancomycin-resistant enterococci and carbapenem-resistant Acinetobacter 4. Dedicated nursing staff
5. Promotion of hand hygiene
    176 Retrospective20-bed surgical ICU in a tertiary care hospital, Miami, FLNo data1. Point prevalence surveillanceControl of CPE spread
2. Isolation and contact precautions for CPE patients
3. Dedicated nursing staff
4. Daily chlorhexidine baths on all patients
5. Environmental cleaning after every shift and evaluation with environmental cultures
6. Educational campaigns
    177 Retrospective70-bed long-term acute care hospital, Chicago, IL1. Active surveillance on admission1. Active surveillance cultures for CPE and point prevalence surveys during the interventionColonization prevalence of CPE decreased progressively, from 21% to 12, 6, 3, and 0%
2. Baseline point prevalence surveillance2. Isolation and contact precautions for CPE patients
3. Preemptive isolation of high-risk patients
4. Environmental cultures and enhanced environmental cleaning
5. Daily chlorhexidine baths for all patients
6. Educational campaign
    83 RetrospectiveLong-term acute care hospital, South FloridaNo data1. Active surveillance cultureTermination of the outbreak
2. Point prevalence survey
3. Isolation and contact precautions for CPE patients
4. Dedicated nursing staff and equipment
    106 RetrospectiveTertiary care hospital, Puerto RicoNo data1. Contact precautions for CPE patientsControl of the outbreak
2. Cohorting of CPE patients
3. Dedicated nursing staff
4. Hand hygiene audits
5. ICU closure
6. Restriction of broad-spectrum antibiotics
7. Active surveillance on admission to high-risk units (ICU, diabetes ward) and weekly thereafter
    15 RetrospectiveTertiary care hospital, Tel Hashomer, Israel1. Contact precautions for CPE cases1. Active surveillance on admission to ICU and in step-down units and weekly thereafterIncidence decreased from 6.93 to 1.8 CPE cases per 10,000 patient-days
2. In other departments, active surveillance of patients with epidemiologic links to CPE carriers
3. Daily reporting of CPE cases to hospital manager and the national coordinator
    53 Prospective intervention studyTertiary care hospital, Rehovot, IsraelNo data1. Active surveillance on admission to ICU, in roommates of new CPE cases or carriers, and in patients at high risk for carriageIncidence decreased from 8.2 to 0.5 CPE case per 10,000 patient-days
2. Isolation-cohorting and contact precautions for CPE cases and carriers
3. Dedicated nursing staff
4. Environmental cleaning and disinfecting during hospital stay and after discharge
5. Education and training to all medical staff members, patients, and caregivers
6. Automatic warning system
    234 Prospective intervention study27 acute care hospitals, IsraelNo data1. Isolation-cohorting and contact precautions for CPE patients and carriersMonthly incidence decreased from 55.5 to 11.7 CPE cases per 100,000 patient-days
2. Dedicated nursing staff and equipment
3. Mandatory reporting to public health authorities of every CPE case
4. Establishment of Task Force on Antimicrobial Resistance and Infection Control