Matan J. Cohen, MD, MPH, of the Center for Clinical Quality and Safety at Hadassah-Hebrew University Medical Center in Jerusalem, and colleagues, report in the latest issue of Infection Control and Hospital Epidemiology that patient cohorting, supplemented by widespread patient surveillance culturing, played a pivotal role in controlling the epidemic spread of carbapenem-resistant Klebsiella pneumoniae (CRKP).
Through consecutive intervention analyses of all patients admitted to a 775-bed tertiary care medical center in Jerusalem from 2006 through 2010, the researchers assessed the effects of four interventions: a policy of isolation for patients colonized or infected with CRKP in single rooms; cohorting of CRKP patients with dedicated nursing staff and screening of patients neighboring a patient newly identified as a carrier of CRKP; weekly active surveillance of intensive care unit patients; and selective surveillance of patients admitted to the emergency department. Interrupted regression analysis and change-point analysis were used to assess the effect of each intervention on the CRKP epidemic.
Cohen, et al. report that on its own, patient isolation failed to control the spread of CRKP, with incidence increasing to a peak of 30 new cases per 1,000 hospital beds per month. They add that the institution of patient cohorting led to a steep decline in the incidence of CRKP acquisition, and that introduction of active surveillance interventions was followed by a decrease in the incidence of CRKP-positive clinical cultures but an increase in the incidence of CRKP-positive screening cultures. The mean prevalence of CRKP positivity for the period after cohorting began showed a statistically significant change from the mean prevalence in the preceding period.
Reference: Cohen MJ, Block C, Levin PD, Schwartz C, Gross I, Weiss Y, Moses AE and Benenson S. Institutional Control Measures to Curtail the Epidemic Spread of Carbapenem-Resistant Klebsiella pneumoniae: A 4-Year Perspective. Infection Control and Hospital Epidemiol. Vol. 32, No. 7. July 2011.