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National intervention halves CRE incidence across Israeli LTCFs
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A national intervention in Israel targeting carbapenem-resistant Enterobacteriaceae, or CRE, led to a 50% reduction in the infections in long-term care facilities over a 7-year period, according to recent findings published in Clinical Infectious Diseases.
Debby Ben-David, MD, of Israel’s National Center for Infection Control (NCIC), and colleagues attributed the success of the intervention to active surveillance and localized prevention measures.
“Our experience supports the assertion that regional interventions are the most effective strategy in preventing the spread of CRE,” they wrote.
NCIC implemented the national intervention in more than 300 long-term care facilities (LTCFs) in 2008, approximately 2 years after CRE was introduced in Israeli hospitals. The intervention focused on improving basic infection control strategies and CRE containment measures. It was tailored to each setting based on CRE prevalence and risk factors. As part of the intervention, CRE prevalence was actively monitored and epidemiological investigations were immediately conducted to address interfacility transmissions. The national intervention was managed by a “dedicated” infection control nurse who regularly communicated with facilities and coordinated educational sessions.
More than 5,265 CRE acquisitions were identified in LTCFs from January 2009 to December 2015. Over this period, acquisition rates declined approximately 50% across all LTCF types, including post-acute-care hospitals, nursing facilities and nursing homes. By 2015, the acquisition rates in each facility were 1.2 per 10,000 patient-days in post-acute-care hospitals, 0.8 per 10,000 patient-days in skilled nursing facilities and 0.3 per 10,000 patient-days in nursing homes. About 60% of all CRE acquisitions were detected among long-term care residents transferring to acute-care hospitals.
Since the intervention, the number of skilled nursing facilities and nursing homes reporting five or more CRE acquisitions each year decreased from 35 to 11. In post-acute-care hospitals, the point prevalence of newly identified CRE carriage significantly decreased from 12.3% to 0.8%.
The researchers used a 16-element infection control score to measure prevention efforts in post-acute-care hospitals. Overall, the infection control score increased in these facilities from 6.9 in 2008 to 15.3 in 2015. There was a significant association between the infection control score and CRE prevalence. For each 1-point increase in score, CRE prevalence decreased 1.1% (95% CI, 0.7-1.5).
A key component of the intervention was real-time notification of CRE detection and contact tracing across various facilities, according to the researchers. This resulted in a substantial reduction not only in LTCFs, but also in acute-care hospitals, they said.
“In conclusion, this study demonstrates that a national coordinated intervention implemented in LTCFs led to a sustained decrease in CRE incidence and prevalence,” Ben-David and colleagues wrote. “Establishing a national network that enables daily communication between all facilities in a region is an essential element in national strategies for CRE control, in conjunction with attention to basic infection control and early identification of carriers.” – by Stephanie Viguers
Disclosures: Ben-David reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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