Infection prevention and control measures and tools for the prevention of entry of carbapenem-resistant Enterobacteriaceae into healthcare settings: guidance from ECDC

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On the occasion of the 10th European Antibiotic Awareness Day, the European Centre for Disease Prevention and Control (ECDC) published a new guidance on how to prevent the entry and spread of carbapenemase-producing Enterobacteriaceae (CRE) into healthcare settings. The guidance features a series of tables and a flowchart with information on how to assess and manage patients who may be “at-risk” for carrying CRE when they are admitted to a healthcare setting. These easy-to-use tables and flowchart can hopefully be helpful to healthcare workers to easily identify those “at-risk” patients and implement appropriate infection prevention and control measures in a timely manner.

Carbapenem-resistant Enterobacteriaceae (CRE), in which Escherichia coli and Klebsiella pneumoniae predominate, are responsible for a large number of patient deaths and high hospital costs. Patients who are “carriers” of CRE are considered “at-risk” for importing these multidrug-resistant bacteria into healthcare settings and spreading them to other patients.

The purpose of this guidance is to assist frontline healthcare workers in identifying “at-risk” patients easily when admitted to a healthcare setting and implementing infection prevention and control (IPC) measures in a timely manner, on admission, to prevent CRE from spreading in the facility.

The following risk factors may put patients “at-risk” for carriage of CRE: a) a history of an overnight stay in a healthcare setting in the last 12 months; b) dialysis dependence or cancer chemotherapy in the last 12 months; c) known previous carriage of CRE in the last 12 months; and d) epidemiological linkage to a known carrier of CRE.

If patients who are admitted to a healthcare setting are known CRE carriers or potential carriers, preliminary supplemental measures such as pre-emptive isolation, active screening for CRE and contact precautions should be implemented on admission. Patients who are confirmed positive for CRE will need supplemental measures, and their status should be communicated to the receiving facilities in case they are transferred between healthcare settings.

The ECDC guidance outlines the epidemiological profiles that place patients “at-risk” for CRE carriage, as well as the IPC measures and the flowchart summarizing the decision-making process, in printable table format, to assist frontline workers and IPC teams in their evaluation and decision-making when admitting patients to healthcare settings.

This guidance outlines evidence-based best practices for the prevention of CRE. Measures for intervention can be adopted or adapted to local needs, depending on the availability of financial and structural resources