Success in Controlling Outbreaks in an Intensive Care Unit Using CDC Toolkit Interventions
July 8th, 2014 10:45 am ET - CDC's Safe Healthcare Blog
Dr. Kyle Enfield
Guest Author: Kyle B. Enfield, MD,
Assistant Professor of Medicine,
Assistant Hospital Epidemiologist,
Medical Director, Medical Intensive Care Unit,
University of Virginia
Assistant Professor of Medicine,
Assistant Hospital Epidemiologist,
Medical Director, Medical Intensive Care Unit,
University of Virginia
Infections due to carbapenem-resistantEnterobacteriaceae (CRE) are on the rise globally. These infections have limited therapeutic options, and invasive infections due to CRE are associated with a mortality rate upwards of 40 percent. A scary statistic for patients!
My institution, the University of Virginia Health System, identified our first case of CRE in August 2007. We had low level transmission with periods of improvement; however, in January 2010
we noted both an increase in CRE transmission among patients in the surgical intensive care unit (SICU), as well as a cluster of infections caused by a nosocomial pathogen new to the unit and our institution – extensively drug-resistant Acinetobacter baumannii(XDR-AB).
we noted both an increase in CRE transmission among patients in the surgical intensive care unit (SICU), as well as a cluster of infections caused by a nosocomial pathogen new to the unit and our institution – extensively drug-resistant Acinetobacter baumannii(XDR-AB).It was critical that we address this potential issue head-on in order to ensure positive patient outcomes and do our best to limit our institution’s exposure to CRE. After initial attempts to control these concurrent outbreaks of multidrug-resistant Gram negative pathogens using reinforced standard infection control practices failed, we implemented a bundled set of infection control interventions aimed to assess the prevalence of CRE and XDR-AB colonization or infection in the unit. The collective set of measures we implemented became recommended practice in the Centers for Disease Control and Prevention 2012 Carbapenem-resistant Enterobacteriaceae Toolkit. The interventions were developed by units in collaboration with Infection Prevention and Control and Environmental Services.
As a result of this bundled approach, our CRE incidence came down to 0.1 percent of patient days and remained there. We were able to eliminate XDR-AB and to date no new drug-resistant A. baumannii has been seen in our hospital. The real strength of the intervention was the buy-in of the unit based leadership team and bedside clinicians implementing this strategy.
As a result of this bundled approach, our CRE incidence came down to 0.1 percent of patient days and remained there. We were able to eliminate XDR-AB and to date no new drug-resistant A. baumannii has been seen in our hospital. The real strength of the intervention was the buy-in of the unit based leadership team and bedside clinicians implementing this strategy.
While we continue to have sporadic patients with CRE in our institution, we have not seen a similar incidence rate since this intervention. We continue to screen units with a known CRE patient for evidence of transmission and have an active plan in place to implement this strategy again, if needed. Our goal remains to ensure the best possible patient outcomes in regards to CRE.
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