title: Successful control of an outbreak of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae at a long-term acute care hospital.
abstract: OBJECTIVE
  To determine the effect of a bundle of infection control interventions on the horizontal transmission of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae during an outbreak.
  
  
  METHODS
  Quasi-experimental study. Setting. Long-term acute care hospital. Intervention. On July 23, 2008, a bundled intervention was implemented: daily 2% chlorhexidine gluconate baths for patients, enhanced environmental cleaning, surveillance cultures at admission, serial point prevalence surveillance (PPS), isolation precautions, and training of personnel. Baseline PPS was performed before the intervention was implemented. Any gram-negative rod isolate suspected of KPC production underwent a modified Hodge test and, if results were positive, confirmatory polymerase chain reaction testing. Clinical cases were defined to occur for patients whose samples yielded KPC-positive gram-negative rods in clinical cultures.
  
  
  RESULTS
  Baseline PPS performed on June 17, 2008, showed a prevalence of colonization with KPC-producing isolates of 21% (8 of 39 patients screened). After implementation of the intervention, monthly PPS was performed 5 times, which showed prevalences of colonization with KPC-producing isolates of 12%, 5%, 3%, 0%, and 0% (P < .001). From January 1, 2008, until the intervention, 8 KPC-positive clinical cases--suspected to be due to horizontal transmission--were detected. From implementation of the intervention through December 31, 2008, only 2 KPC-positive clinical cases, both in August 2008, were detected. From January 1 through December 31, 2008, 8 patients were detected as carriers of KPC-producing isolates at admission to the institution, 4 patients before and 4 patients after the intervention.
  
  
  CONCLUSIONS
  A bundled intervention was successful in preventing horizontal spread of KPC-producing gram-negative rods in a long-term acute care hospital, despite ongoing admission of patients colonized with KPC producers.
authors.affiliation: Division of Infectious Diseases, University of Miami, and Jackson Memorial Hospital, Miami, Florida 33136-1096, USA. smunozprice@med.miami.edu
authors.forename: L Silvia
authors.initials: LS
authors.lastname: Munoz-Price
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hayden
authors.forename: Karen
authors.initials: K
authors.lastname: Lolans
authors.forename: Sarah
authors.initials: S
authors.lastname: Won
authors.forename: Karen
authors.initials: K
authors.lastname: Calvert
authors.forename: Michael
authors.initials: M
authors.lastname: Lin
authors.forename: Alexander
authors.initials: A
authors.lastname: Stemer
authors.forename: Robert A
authors.initials: RA
authors.lastname: Weinstein
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000096:biosynthesis*; D015780:Carbapenems / Q000494:pharmacology; D002710:Chlorhexidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D003470:Culture Media; D004196:Disease Outbreaks / Q000517:prevention & control*; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology; D008134:Long-Term Care; D008826:Microbial Sensitivity Tests; D010356:Patient Isolation; D011159:Population Surveillance / Q000379:methods; D015995:Prevalence; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D003470:Culture Media; D001618:beta-Lactamases; C063912:carbapenemase; C010882:chlorhexidine gluconate; D002710:Chlorhexidine