Division of Public HealthCRE Surveillance and Prevention of Transmission in Healthcare Settings

Gwen Borlaug, CIC, MPHCoordinator, Healthcare-Associated Infections Prevention ProgramWSLH AST ConferenceMay 10, 2012

Key premise

The laboratory is a critical partner in preventing transmission of carbapenem-resistant Enterobacteriaceae (CRE) in healthcare settings.

Enterobacteriaceae

Gram negative bacteria usually residing in the GI tract

Ferment glucose Examples

– 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 healthcare-associated infections (HAI) in 2006-07.

Hidron et al. Infect Control Hosp Epidemiol 2008;29:996-1011

CRE

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

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)– Includes specialty acute care such as children’s,

orthopedic, heart– Excludes behavioral, AODA, psychiatric, rehabilitation

hospitals

Findings to date

11 reported events; 8 cases– 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

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, MPHDivision of Public Health

1 West Wilson Street Room 318Madison, WI 53702

608-267-7711gwen.borlaug@wi.gov