PUBLIC HEALTH DEPARTMENTS
- Ensure the laboratory rapidly notifies infection prevention and clinical staff when a patient or resident with CRE is identified.
- Consider tracking CRE LabID events using the NHSN MDRO module (PDF).
- Know the local epidemiology and prevalence of CRE in your region.
- Understand patient risk factors and high-risk facilities for CRE in your jurisdiction, such as Long Term Acute Care (LTAC) hospitals and skilled nursing facilities that provide ventilator care (vSNF).
- Work with local healthcare facilities to ensure awareness of CRE.
- Perform CP-CRE colonization testing of patients and residents who are epidemiologically-linked to a patient newly identified with CP-CRE. Epi-linked patients include roommates, patients residing on the same unit, or patients exposed to the same medical device, for example, duodenoscopes.
- Consider performing CP-CRE colonization testing upon admission of high-risk patients. High-risk patients include those admitted from LTAC or vSNF, or have received healthcare outside the United States during the prior 12 months.
- Access CP-CRE colonization testing services free of charge using the CDC Antibiotic Resistance Laboratory Network (ARLN). To learn more, view slides from a CDPH webinar about ARLN (PDF) and contact the HAI Program to initiate a request.
Infection Control Measures
- In acute care hospitals and high-acuity post-acute care settings (for example, LTAC) place patients infected or colonized with CP-CRE in a single room whenever possible, and implement Standard and Contact precautions.
- Use the CRE Quicksheet (PDF) for guidance on investigating CRE cases and clusters.
- Be prepared to conduct a site visit when necessary and assess implementation of infection control strategies. Contact the HAI Program for more information on performing infection control assessments.
- During an outbreak, consider requesting the facility provide documentation of their own adherence monitoring.
- Ensure thorough daily and terminal environmental cleaning. Focus on high-touch surfaces or any shared reusable medical equipment.
- Review environmental cleaning checklists available on the CDPH HAI Program website.
- Communicate CRE status to the receiving facility ahead of time to ensure appropriate care is maintained when transferring a patient/resident.
- Use the HAI Program interfacility transfer form (PDF) during all patient transfers.
- Set expectations for facilities to communicate CRE status when transferring patients/residents to another healthcare facility.
- During an outbreak, consider requesting facilities notify public health of all discharges and transfers involving individuals with CRE.
- Implement strategies to limit use of broad spectrum antimicrobial agents and an antimicrobial stewardship program (ASP) to promote and measure appropriate antimicrobial use by optimizing the selection, dosing, route, and duration of therapy.