National Policy for Carbapenem-Resistant Enterobacteriaceae (CRE) Clearance and Discontinuation of Contact Precautions for CRE Carriers in Post–Acute Care Hospitals in Israel: Impact on Isolation-Days and New Acquisitions
Abstract Background In 2009, the Israeli Ministry of Health implemented in post–acute care hospitals (PACHs) a process of discontinuing carbapenem-resistant Enterobacteriaceae (CRE) carrier status. We evaluated the policy’s impact on isolation-days, CRE prevalence among known carriers who had comple...
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| Veröffentlicht in: | Clinical infectious diseases 2021-03, Vol.72 (5), p.829-835 |
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| creator | Ben-David, Debby Masarwa, Samira Fallach, Noga Temkin, Elizabeth Solter, Ester Carmeli, Yehuda Schwaber, Mitchell J |
| description | Abstract
Background
In 2009, the Israeli Ministry of Health implemented in post–acute care hospitals (PACHs) a process of discontinuing carbapenem-resistant Enterobacteriaceae (CRE) carrier status. We evaluated the policy’s impact on isolation-days, CRE prevalence among known carriers who had completed clearance testing, and CRE acquisition among noncarriers.
Methods
This retrospective study summarized findings from all 15 PACHs in 2009–2017. CRE carriers were considered cleared and removed from contact isolation after 2 rectal cultures negative for CRE and polymerase chain reaction negative for carbapenemases. Data sources included routine surveillance and 4 point prevalence surveys conducted from 2011 to 2017.
Results
During the study period, 887 of 6101 CRE carriers (14.5%) completed clearance testing. From 2013 to 2016, the percentage of patient-days in CRE isolation decreased from 9.4% to 3.9% (P = .008). In all surveys combined, there were 819 known CRE carriers; 411 (50%) had completed clearance testing. Of these, 11.4% (47/411) were CRE positive in the survey. At the ward level, the median percentage of patients with no CRE history who were positive on survey decreased from 11.3% in 2011 to 0% in 2017 (P < .001). We found no ward-level correlation between the proportion of carriers who completed clearance and new acquisitions (ρ = 0.02, P = .86).
Conclusions
A process for discontinuing CRE carrier status in PACHs led to a significant reduction in the percentage of patient-days in contact isolation without increasing CRE acquisitions among noncarriers.
After implementation of Carbapenem-Resistant Enterobacteriaceae (CRE) clearance testing in post–acute care hospitals, the percentage of patient-days in CRE isolation decreased from 9.4% to 3.9%, with no increase in risk of CRE acquisition among noncarriers. |
| doi_str_mv | 10.1093/cid/ciaa123 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2352658262</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/cid/ciaa123</oup_id><sourcerecordid>2352658262</sourcerecordid><originalsourceid>FETCH-LOGICAL-c320t-e8f35c518c7d025ef9b8cb0a4e501997202431c5fa9296accd3d6fc42d17b7ee3</originalsourceid><addsrcrecordid>eNp9UU1v1DAQjRCIlsKJO_IJtUIBf8T54LZKF7pSVaoVnKOJM5GMEju1HaG98R_4gZX4JTjZhSOH0Yxn3rxnzUuS14y-Z7QSH5TuYgAwLp4k50yKIs1lxZ7GmsoyzUpRniUvvP9OKWMllc-TM8GpyDKWnSePdxC0NTCQeztodSC9daQG18KEBsd0j177ACaQrQnobAsqJg0KAcllvd9ekXpAcGAUEjAdudZeWRO0mVdiYntSx3dcI_cOFcxL1x9l9ttFyml0nmgTf-DD75-_NmoOuAyQ3Fg_6QDDOt55Bzh8JLtxWtjs0rHDqpJew8Gv8nf4g2zUw6y9XoVeJs_6uI-vTvki-fZp-7W-SW-_fN7Vm9tUxVuEFMteSCVZqYqOcol91ZaqpZChpKyqCk55JpiSPVS8ykGpTnR5rzLesaItEMVFcnnknZx9mNGHZoyHwGEAg3b2DReS57LkOY_Qd0eoctZ7h30zOT2COzSMNoujTXS0OTka0W9OxHM7YvcP-9fCCHh7BNh5-i_TH1TUrxg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2352658262</pqid></control><display><type>article</type><title>National Policy for Carbapenem-Resistant Enterobacteriaceae (CRE) Clearance and Discontinuation of Contact Precautions for CRE Carriers in Post–Acute Care Hospitals in Israel: Impact on Isolation-Days and New Acquisitions</title><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Ben-David, Debby ; Masarwa, Samira ; Fallach, Noga ; Temkin, Elizabeth ; Solter, Ester ; Carmeli, Yehuda ; Schwaber, Mitchell J</creator><creatorcontrib>Ben-David, Debby ; Masarwa, Samira ; Fallach, Noga ; Temkin, Elizabeth ; Solter, Ester ; Carmeli, Yehuda ; Schwaber, Mitchell J ; Israel Long-term Care Facility (LTCF) CRE Working Group ; Israel Long-term Care Facility (LTCF) CRE Working Group</creatorcontrib><description>Abstract
Background
In 2009, the Israeli Ministry of Health implemented in post–acute care hospitals (PACHs) a process of discontinuing carbapenem-resistant Enterobacteriaceae (CRE) carrier status. We evaluated the policy’s impact on isolation-days, CRE prevalence among known carriers who had completed clearance testing, and CRE acquisition among noncarriers.
Methods
This retrospective study summarized findings from all 15 PACHs in 2009–2017. CRE carriers were considered cleared and removed from contact isolation after 2 rectal cultures negative for CRE and polymerase chain reaction negative for carbapenemases. Data sources included routine surveillance and 4 point prevalence surveys conducted from 2011 to 2017.
Results
During the study period, 887 of 6101 CRE carriers (14.5%) completed clearance testing. From 2013 to 2016, the percentage of patient-days in CRE isolation decreased from 9.4% to 3.9% (P = .008). In all surveys combined, there were 819 known CRE carriers; 411 (50%) had completed clearance testing. Of these, 11.4% (47/411) were CRE positive in the survey. At the ward level, the median percentage of patients with no CRE history who were positive on survey decreased from 11.3% in 2011 to 0% in 2017 (P < .001). We found no ward-level correlation between the proportion of carriers who completed clearance and new acquisitions (ρ = 0.02, P = .86).
Conclusions
A process for discontinuing CRE carrier status in PACHs led to a significant reduction in the percentage of patient-days in contact isolation without increasing CRE acquisitions among noncarriers.
After implementation of Carbapenem-Resistant Enterobacteriaceae (CRE) clearance testing in post–acute care hospitals, the percentage of patient-days in CRE isolation decreased from 9.4% to 3.9%, with no increase in risk of CRE acquisition among noncarriers.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciaa123</identifier><identifier>PMID: 32034414</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Anti-Bacterial Agents - therapeutic use ; Carbapenem-Resistant Enterobacteriaceae ; Cross Infection - epidemiology ; Cross Infection - prevention & control ; Enterobacteriaceae Infections - drug therapy ; Enterobacteriaceae Infections - epidemiology ; Enterobacteriaceae Infections - prevention & control ; Hospitals ; Humans ; Israel - epidemiology ; Policy ; Retrospective Studies ; Subacute Care</subject><ispartof>Clinical infectious diseases, 2021-03, Vol.72 (5), p.829-835</ispartof><rights>The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. 2020</rights><rights>The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c320t-e8f35c518c7d025ef9b8cb0a4e501997202431c5fa9296accd3d6fc42d17b7ee3</citedby><cites>FETCH-LOGICAL-c320t-e8f35c518c7d025ef9b8cb0a4e501997202431c5fa9296accd3d6fc42d17b7ee3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32034414$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ben-David, Debby</creatorcontrib><creatorcontrib>Masarwa, Samira</creatorcontrib><creatorcontrib>Fallach, Noga</creatorcontrib><creatorcontrib>Temkin, Elizabeth</creatorcontrib><creatorcontrib>Solter, Ester</creatorcontrib><creatorcontrib>Carmeli, Yehuda</creatorcontrib><creatorcontrib>Schwaber, Mitchell J</creatorcontrib><creatorcontrib>Israel Long-term Care Facility (LTCF) CRE Working Group</creatorcontrib><creatorcontrib>Israel Long-term Care Facility (LTCF) CRE Working Group</creatorcontrib><title>National Policy for Carbapenem-Resistant Enterobacteriaceae (CRE) Clearance and Discontinuation of Contact Precautions for CRE Carriers in Post–Acute Care Hospitals in Israel: Impact on Isolation-Days and New Acquisitions</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Abstract
Background
In 2009, the Israeli Ministry of Health implemented in post–acute care hospitals (PACHs) a process of discontinuing carbapenem-resistant Enterobacteriaceae (CRE) carrier status. We evaluated the policy’s impact on isolation-days, CRE prevalence among known carriers who had completed clearance testing, and CRE acquisition among noncarriers.
Methods
This retrospective study summarized findings from all 15 PACHs in 2009–2017. CRE carriers were considered cleared and removed from contact isolation after 2 rectal cultures negative for CRE and polymerase chain reaction negative for carbapenemases. Data sources included routine surveillance and 4 point prevalence surveys conducted from 2011 to 2017.
Results
During the study period, 887 of 6101 CRE carriers (14.5%) completed clearance testing. From 2013 to 2016, the percentage of patient-days in CRE isolation decreased from 9.4% to 3.9% (P = .008). In all surveys combined, there were 819 known CRE carriers; 411 (50%) had completed clearance testing. Of these, 11.4% (47/411) were CRE positive in the survey. At the ward level, the median percentage of patients with no CRE history who were positive on survey decreased from 11.3% in 2011 to 0% in 2017 (P < .001). We found no ward-level correlation between the proportion of carriers who completed clearance and new acquisitions (ρ = 0.02, P = .86).
Conclusions
A process for discontinuing CRE carrier status in PACHs led to a significant reduction in the percentage of patient-days in contact isolation without increasing CRE acquisitions among noncarriers.
After implementation of Carbapenem-Resistant Enterobacteriaceae (CRE) clearance testing in post–acute care hospitals, the percentage of patient-days in CRE isolation decreased from 9.4% to 3.9%, with no increase in risk of CRE acquisition among noncarriers.</description><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Carbapenem-Resistant Enterobacteriaceae</subject><subject>Cross Infection - epidemiology</subject><subject>Cross Infection - prevention & control</subject><subject>Enterobacteriaceae Infections - drug therapy</subject><subject>Enterobacteriaceae Infections - epidemiology</subject><subject>Enterobacteriaceae Infections - prevention & control</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Israel - epidemiology</subject><subject>Policy</subject><subject>Retrospective Studies</subject><subject>Subacute Care</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UU1v1DAQjRCIlsKJO_IJtUIBf8T54LZKF7pSVaoVnKOJM5GMEju1HaG98R_4gZX4JTjZhSOH0Yxn3rxnzUuS14y-Z7QSH5TuYgAwLp4k50yKIs1lxZ7GmsoyzUpRniUvvP9OKWMllc-TM8GpyDKWnSePdxC0NTCQeztodSC9daQG18KEBsd0j177ACaQrQnobAsqJg0KAcllvd9ekXpAcGAUEjAdudZeWRO0mVdiYntSx3dcI_cOFcxL1x9l9ttFyml0nmgTf-DD75-_NmoOuAyQ3Fg_6QDDOt55Bzh8JLtxWtjs0rHDqpJew8Gv8nf4g2zUw6y9XoVeJs_6uI-vTvki-fZp-7W-SW-_fN7Vm9tUxVuEFMteSCVZqYqOcol91ZaqpZChpKyqCk55JpiSPVS8ykGpTnR5rzLesaItEMVFcnnknZx9mNGHZoyHwGEAg3b2DReS57LkOY_Qd0eoctZ7h30zOT2COzSMNoujTXS0OTka0W9OxHM7YvcP-9fCCHh7BNh5-i_TH1TUrxg</recordid><startdate>20210301</startdate><enddate>20210301</enddate><creator>Ben-David, Debby</creator><creator>Masarwa, Samira</creator><creator>Fallach, Noga</creator><creator>Temkin, Elizabeth</creator><creator>Solter, Ester</creator><creator>Carmeli, Yehuda</creator><creator>Schwaber, Mitchell J</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20210301</creationdate><title>National Policy for Carbapenem-Resistant Enterobacteriaceae (CRE) Clearance and Discontinuation of Contact Precautions for CRE Carriers in Post–Acute Care Hospitals in Israel: Impact on Isolation-Days and New Acquisitions</title><author>Ben-David, Debby ; Masarwa, Samira ; Fallach, Noga ; Temkin, Elizabeth ; Solter, Ester ; Carmeli, Yehuda ; Schwaber, Mitchell J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c320t-e8f35c518c7d025ef9b8cb0a4e501997202431c5fa9296accd3d6fc42d17b7ee3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Carbapenem-Resistant Enterobacteriaceae</topic><topic>Cross Infection - epidemiology</topic><topic>Cross Infection - prevention & control</topic><topic>Enterobacteriaceae Infections - drug therapy</topic><topic>Enterobacteriaceae Infections - epidemiology</topic><topic>Enterobacteriaceae Infections - prevention & control</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Israel - epidemiology</topic><topic>Policy</topic><topic>Retrospective Studies</topic><topic>Subacute Care</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ben-David, Debby</creatorcontrib><creatorcontrib>Masarwa, Samira</creatorcontrib><creatorcontrib>Fallach, Noga</creatorcontrib><creatorcontrib>Temkin, Elizabeth</creatorcontrib><creatorcontrib>Solter, Ester</creatorcontrib><creatorcontrib>Carmeli, Yehuda</creatorcontrib><creatorcontrib>Schwaber, Mitchell J</creatorcontrib><creatorcontrib>Israel Long-term Care Facility (LTCF) CRE Working Group</creatorcontrib><creatorcontrib>Israel Long-term Care Facility (LTCF) CRE Working Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ben-David, Debby</au><au>Masarwa, Samira</au><au>Fallach, Noga</au><au>Temkin, Elizabeth</au><au>Solter, Ester</au><au>Carmeli, Yehuda</au><au>Schwaber, Mitchell J</au><aucorp>Israel Long-term Care Facility (LTCF) CRE Working Group</aucorp><aucorp>Israel Long-term Care Facility (LTCF) CRE Working Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>National Policy for Carbapenem-Resistant Enterobacteriaceae (CRE) Clearance and Discontinuation of Contact Precautions for CRE Carriers in Post–Acute Care Hospitals in Israel: Impact on Isolation-Days and New Acquisitions</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2021-03-01</date><risdate>2021</risdate><volume>72</volume><issue>5</issue><spage>829</spage><epage>835</epage><pages>829-835</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>Abstract
Background
In 2009, the Israeli Ministry of Health implemented in post–acute care hospitals (PACHs) a process of discontinuing carbapenem-resistant Enterobacteriaceae (CRE) carrier status. We evaluated the policy’s impact on isolation-days, CRE prevalence among known carriers who had completed clearance testing, and CRE acquisition among noncarriers.
Methods
This retrospective study summarized findings from all 15 PACHs in 2009–2017. CRE carriers were considered cleared and removed from contact isolation after 2 rectal cultures negative for CRE and polymerase chain reaction negative for carbapenemases. Data sources included routine surveillance and 4 point prevalence surveys conducted from 2011 to 2017.
Results
During the study period, 887 of 6101 CRE carriers (14.5%) completed clearance testing. From 2013 to 2016, the percentage of patient-days in CRE isolation decreased from 9.4% to 3.9% (P = .008). In all surveys combined, there were 819 known CRE carriers; 411 (50%) had completed clearance testing. Of these, 11.4% (47/411) were CRE positive in the survey. At the ward level, the median percentage of patients with no CRE history who were positive on survey decreased from 11.3% in 2011 to 0% in 2017 (P < .001). We found no ward-level correlation between the proportion of carriers who completed clearance and new acquisitions (ρ = 0.02, P = .86).
Conclusions
A process for discontinuing CRE carrier status in PACHs led to a significant reduction in the percentage of patient-days in contact isolation without increasing CRE acquisitions among noncarriers.
After implementation of Carbapenem-Resistant Enterobacteriaceae (CRE) clearance testing in post–acute care hospitals, the percentage of patient-days in CRE isolation decreased from 9.4% to 3.9%, with no increase in risk of CRE acquisition among noncarriers.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>32034414</pmid><doi>10.1093/cid/ciaa123</doi><tpages>7</tpages></addata></record> |
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| ispartof | Clinical infectious diseases, 2021-03, Vol.72 (5), p.829-835 |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Anti-Bacterial Agents - therapeutic use Carbapenem-Resistant Enterobacteriaceae Cross Infection - epidemiology Cross Infection - prevention & control Enterobacteriaceae Infections - drug therapy Enterobacteriaceae Infections - epidemiology Enterobacteriaceae Infections - prevention & control Hospitals Humans Israel - epidemiology Policy Retrospective Studies Subacute Care |
| title | National Policy for Carbapenem-Resistant Enterobacteriaceae (CRE) Clearance and Discontinuation of Contact Precautions for CRE Carriers in Post–Acute Care Hospitals in Israel: Impact on Isolation-Days and New Acquisitions |
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