Guest Author – Brian Currie, MD, MPH
Montefiore Medical Center,
University Hospital and Academic Medical Center for the Albert Einstein College of Medicine
Today I would like to discuss a highly successful patient safety intervention designed to reduce the prevalence of CRE in the ICU units across Montefiore Medical Center (MMC) in the Bronx, N.Y. Funded by AHRQ, this effort used CDC’s infection prevention guidelines to reduce CRE prevalence and was intended to be exportable for replication at other acute care hospitals.
CRE has been widespread in NYC since 2006, including at our medical center. In NYC, CRE has been almost exclusively due to the Klebsiella pneumoniae carbapenemase gene (KPC). At our facilities 40% of the prevalence of KPC was due to patients who were already carrying CRE, prior to their transfer into our facilities from other acute and long term care facilities in the Bronx. My team worked to detect CRE using PCR-based lab tests and protect patients from picking up CRE by rapidly implementing contact isolation precautions for all positive patients.
Our baseline rate was established via weekly peri-rectal swab sampling of all ICU patients (94 beds in 7 units across 3 hospitals) during a four month period. Testing results were not shared with caregivers during the baseline period. However, all health care providers were educated about CRE/KPC and how to stop spread. After roll out, another sampling was initiated for another 4 months that included weekly sampling and sampling all new admissions on arrival on a daily basis. All results were reported within 3 hours of sample pickup and KPC positive patients were immediately placed on contact isolation.
I am thrilled to report that overall our facility reduced KPC in each unit by 53%. The remaining KPC prevalence was almost completely composed of patients who were known to be KPC positive on ICU admission, thus patient to patient transmission was virtually eliminated.
At Montefiore Medical Center, we continue our efforts to protect patients from the threat of CRE and other multi-drug resistant bacteria.