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Healthcare-associated infections (HAI) program

Carbapenem-resistant Enterobacteriaceae (CRE) for Public Health and Healthcare Providers

ABOUT

Carbapenem-resistant Enterobacteriaceae (CRE) are bacteria that are resistant to the broad-spectrum carbapenem class of antibiotics. Patients with CRE infections have significantly worse outcomes than patients with susceptible infections. Certain CRE are resistant because they produce carbapenemase enzymes that make carbapenems ineffective. Carbapenemase genes can be transferred between different kinds of bacteria and lead to the spread of antibiotic resistance.

Carbapenemase-producing CRE (CP-CRE) are increasingly common in some California healthcare settings. Public health and healthcare providers across the continuum of care are coordinating efforts to address CP-CRE in California.

CRE information for patients and families is also available on the HAI Program’s site.

Healthcare providers and public health departments can work together to prevent the emergence and transmission of CRE and other highly drug-resistant infections.

 

COORDINATED CRE PREVENTION STRATEGIES

​HEALTHCARE PROVIDERS

​​PUBLIC HEALTH DEPARTMENTS

​Laboratory Identification

​Surveillance

  • ​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.

​Colonization Testing

  • ​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.

​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.

​Adherence Monitoring

  • ​During an outbreak, consider requesting the facility provide documentation of their own adherence monitoring.

​Environmental Cleaning

  • ​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.

​Interfacility Communication

  • ​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.

​Antimicrobial Stewardship

  • ​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.

​Regional Prevention

​Reporting

 

Additional CRE Resources


For additional information contact the HAI Program at HAIProgram@cdph.ca.gov.

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