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patients are exposed to broad-spectrum antimicrobials) to identify any additional patients colonized with Carbapenem- resistant or Carbapenemase-producing Klebsiella spp. and E.coli. When a case of hospital-associated

CRE is identified, facilities should conduct a single round of active surveillance testing of patients with epidemiologic links to the CRE case (e.g., those patients in the same unit or patients who have been cared for by the same healthcare personnel). The goal of active surveillance is

to identify undetected carriers of Carbapenem-resistant or Carbapenemase- producing Klebsiella spp. and E.coli. Identification of other cases among patients with epidemiologic links to persons with confirmed infection suggests patient-to-patient transmission. In such situations, infection prevention

measures should be vigorously reinforced, and surveillance cultures repeated periodically (e.g., weekly) until no new cases are identified. Situations where periodic point

prevalence surveys repeatedly fail to identify other colonized patients suggest that infection control measures at the facility are effective in controlling transmission. In such instances, consideration should be given to halting active surveillance cultures in response to clinical cases and replacing them with periodic point prevalence

surveys in units with patients at high risk to ensure that Carbapenem-resistant or Carbapenemase-producing Klebsiella spp. and E.coli do not reemerge.

Guidance on infection control Goal: Institute contact precautions to prevent patient-to-patient transmission Contact isolation should include the following steps:  Disposable gloves and gowns available at each bedside

 Alcohol based hand rub available and used

 Environmental surfaces cleaned daily with aerosolized foam quaternary ammonium compound

 Disposable antibacterial wipes containing isopropanol and quaternary ammonium compound for cleaning patient related items at least once a day

 Infection control team participated in daily round

 ACTIVE surveillance cultures by rectal swabs on admission and weekly

 ICU extensively cleaned: environment and patient care items In addition, for all patients culture positive for CRE:

 A copy of antibiogram placed in bedside records

 All infected or colonized patients are moved and gathered at one end of ICU

 Nursing personnel also grouped  Free standing dispensers for alcohol

based hand rub available at bedside

 Disposable antibacterial wipes to clean environment at beginning of 12-hour shift and SOS It has recently been shown that a

strictly enforced infection control policy, combined with analysis of routine rectal surveillance cultures for Carbapenem- resistant organisms, successfully reduced the incidence of Carbapenem resistant K. pneumoniae by 62% over two years. Although transmission of these organisms within the hospital setting was greatly diminished, the organisms were not eradicated, and probably will continue to exist as colonizing bacteria in the general community. Optimistically, one can hope that, in the absence of antibiotic selection pressure, at least some of these resistance-bearing mobile elements will cease to be necessary, and will eventually be discarded by the producing organisms. Realistically, however, one can expect that the bacteria will still survive our best efforts to rid them of these wonderfully effective survival mechanisms. ■


 REFERENCES References available on request (


Department of Clinical Sciences, College

of Medicine, University of Sharjah, UAE 2

Al Qassimi Hospital, Sharjah, UAE


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