title: Institutional control measures to curtail the epidemic spread of carbapenem-resistant Klebsiella pneumoniae: a 4-year perspective.
abstract: OBJECTIVE
  To describe the implementation of an institution-wide, multiple-step intervention to curtail the epidemic spread of carbapenem-resistant Klebsiella pneumoniae (CRKP).
  
  
  METHODS
  Consecutive intervention analyses.
  
  
  METHODS
  All patients admitted to a 775-bed tertiary care medical center in Jerusalem, Israel, from 2006 through 2010.
  
  
  METHODS
  The effects of 4 interventions were assessed: (1) a policy of isolation for patients colonized or infected with CRKP in single rooms, which was started in March 2006; (2) cohorting of CRKP patients with dedicated nursing staff and screening of patients neighboring a patient newly identified as a carrier of CRKP, which was started in March 2007; (3) weekly active surveillance of intensive care unit patients, which was started during August 2008; and (4) selective surveillance of patients admitted to the emergency department, which was started in March 2009. Interrupted regression analysis and change-point analysis were used to assess the effect of each intervention on the CRKP epidemic.
  
  
  RESULTS
  Patient isolation alone failed to control the spread of CRKP, with incidence increasing to a peak of 30 new cases per 1,000 hospital beds per month. Institution of patient cohorting led to a steep decline in the incidence of CRKP acquisition (P < .001). 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 (P < .001).
  
  
  CONCLUSIONS
  The cohorting of patients with dedicated staff, combined with implementation of focused active surveillance, effectively terminated the epidemic spread of CRKP. Cohorting reduced cross-infection within the hospital, and active surveillance allowed for earlier detection of carrier status. Both interventions should be considered in attempts to contain a hospital epidemic.
authors.affiliation: Center for Clinical Quality and Safety, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Matan J
authors.initials: MJ
authors.lastname: Cohen
authors.forename: Colin
authors.initials: C
authors.lastname: Block
authors.forename: Phillip D
authors.initials: PD
authors.lastname: Levin
authors.forename: Carmela
authors.initials: C
authors.lastname: Schwartz
authors.forename: Ilana
authors.initials: I
authors.lastname: Gross
authors.forename: Yuval
authors.initials: Y
authors.lastname: Weiss
authors.forename: Allon E
authors.initials: AE
authors.lastname: Moses
authors.forename: Shmuel
authors.initials: S
authors.lastname: Benenson
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015780:Carbapenems / Q000494:pharmacology; D002353:Carrier State; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D058872:Epidemics / Q000517:prevention & control; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007557:Israel; D007710:Klebsiella Infections / Q000453:epidemiology / Q000517:prevention & control*; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000302:isolation & purification*; D010356:Patient Isolation; D011159:Population Surveillance; D011446:Prospective Studies; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems