The association between infection control interventions and CRE incidence

The aim of this study was to assess the association between infection control (IC) interventions implemented in a referral hospital in Israel and (CRE) incidence | Journal of Hospital Infection

https://www.flickr.com/photos/niaid/13743456084

Image source: NIAID – FLickr // CC BY 2.0

Image shows a human neutrophil interacting with Klebsiella pneumoniae (pink).

Background: Israel experienced a national outbreak of carbapenem-resistant Enterobacteriaceaee (CRE) starting in 2006.

Methods: Retrospective quasi-experimental study of prospectively collected data. CRE incidence, defined as the number of patients newly acquiring CRE in surveillance or clinical samples per 100,000 hospitals days (HD), was plotted quarterly between 2005 to 2016. IC interventions were applied at different time-points throughout this period. We collected data on IC staffing, number of rectal surveillance cultures and carbapenem consumption. We used auto-correlated segmented linear regression analysis to assess the time-points where a significant change in the CRE incidence trend occurred and assessed the relationship between the timing of IC intervention implementation and observed CRE trends. Trends between time-points are expressed as quarterly percent change (QPC) with 95% confidence intervals.

Findings: Between 2005-2008, CRE incidence increased significantly, QPC 19.7% (11.5-28.4%), reaching a peak of 186.6 new acquisitions/100,000 HD. From mid-2011 until the end of follow-up, there was a significant decreasing incidence trend, QPC -4.5 (-6.4 to -2.5). Cohorting of patients, screening of contacts and high-risk patients on admission were insufficient to control the epidemic. Improved hand hygiene compliance, cohorting with dedicated nursing staff, addition of regular screening in high-risk departments and carbapenem restriction were required. Decreasing CRE incidence was observed with an ID/IC staffing of 1.2-1.5/100 beds and 20,000-36,000 yearly CRE surveillance samples.

Conclusions: A multifaceted hospital-wide intervention program is required to control CRE in hospital settings.

Full reference: Hussein, K. et al. (2017) The association between infection control interventions and CRE incidence in an endemic hospital. Journal of Hospital Infection. Published online: 22 July 2017

Preventing healthcare associated gram-negative bacterial bloodstream infections

An improvement resource to help health and social care economies reduce the number of gram-negative bloodstream infections (BSIs) with an initial focus on Escherichia coli (E.coli).

This resource pack makes suggestions rather than prescriptions about how to reduce these infections and pulls together a collection of tools for local teams. The authors recognise that effective prevention of infection is multifaceted and requires strong leadership, effective training programmes, and evidence-based guidelines and interventions.  biology-220005_1280

The report groups the resources under the following sections:

Reducing infections in the NHS

Department of Health | Published online: 10 November 2016

http://wellcomeimages.org/indexplus/result.html?_IXMAXHITS_=1&_IXACTION_=query&_IXFIRST_=26&_IXSR_=Y1PTh2TptHP&_IXSS_=_IXFPFX_%3dtemplates%252ft%26_IXMAXHITS_%3d250%26c%3d%2522historical%2bimages%2522%2bOR%2b%2522contemporary%2bimages%2522%2bOR%2b%2522corporate%2bimages%2522%2bOR%2b%2522contemporary%2bclinical%2bimages%2522%26_IXFIRST_%3d1%26%252asform%3dwellcome%252dimages%26%2524%2b%2528%2528with%2bwi_sfgu%2bis%2bY%2529%2band%2bnot%2b%2528%2522contemporary%2bclinical%2bimages%2522%2bindex%2bwi_collection%2bor%2b%2522corporate%2bimages%2522%2bindex%2bwi_collection%2529%2529%2band%2bnot%2bwith%2bsys_deleted%3d%252e%26%2524%253dsi%3dtext%26_IXACTION_%3dquery%26%3d%26_IXrescount%3d108%26_IXINITSR_%3dy%26%2524%253dsort%3dsort%2bsortexpr%2bimage_sort%26_IXshc%3dy%26%2524%253ds%3de%2bcoli&_IXSPFX_=templates%2ft&_IXFPFX_=templates%2ft

Image source: David Gregory & Debbie Marshall – Wellcome Images // CC BY-NC-ND 4.0

Image shows electron micrograph of Escherichia coli close-up

Plans to prevent hospital infections include more money for hospitals who reduce infection rates and publishing E. coli rates by local area.

Health Secretary Jeremy Hunt has launched new plans to reduce infections in the NHS. He announced government plans to halve the number of gram-negative bloodstream infections by 2020 at an infection control summit.

E. coli infections – which represent 65% of what are called gram-negative infections – killed more than 5,500 NHS patients last year and are set to cost the NHS £2.3 billion by 2018. There is also large variation in hospital infection rates, with the worst performers having more than 5 times the number of cases than the best performing hospitals.

Infection rates can be cut with better hygiene and improved patient care in hospitals, surgeries and care homes, such as ensuring staff, patients and visitors regularly wash their hands. People using insertion devices such as catheters, which are often used following surgery, can develop infections like E. coli if they are not inserted properly, left in too long or if patients are not properly hydrated and going to the toilet regularly.

Read the full news story here

Reducing infections in the NHS

Plans to prevent hospital infections include more money for hospitals who reduce infection rates and publishing E. coli rates by local area.

sink-400276_1280

New plans to reduce infections in the NHS have been announced by the government at an infection control summit. Health Secretary Jeremy Hunt announced the plan to halve the number of gram-negative bloodstream infections by 2020.

Infection rates can be cut with better hygiene and improved patient care in hospitals, surgeries and care homes, such as ensuring staff, patients and visitors regularly wash their hands. People using insertion devices such as catheters, which are often used following surgery, can develop infections like E. coli if they are not inserted properly, left in too long or if patients are not properly hydrated and going to the toilet regularly.

These new plans build on the progress made in infection control since 2010 – the number of MRSA cases has been reduced by 57% and C. difficile by 45%.

Read more via Department of Health