title: An effective intervention to limit the spread of an epidemic carbapenem-resistant Klebsiella pneumoniae strain in an acute care setting: from theory to practice.
abstract: BACKGROUND
  The highly transmissible and virulent carbapenem-resistant Klebsiella pneumoniae (CRKP) KPC-3 strain has been spreading in our medical center and in other centers in Israel since 2006. An intervention that aimed to diminish its prevalence was constructed and applied in our institute.
  
  
  METHODS
  We analyzed the efficacy of the intervention during the years 2006-2010 using quasi-experimental methodology. The intervention included guidelines for patient isolation, cohorting, and environment cleaning; education of staff; and a computerized notification system that flags CRKP carriers and provides instructions. The efficacy of the program was evaluated through 3 quantifiable parameters: incidence of CRKP isolates from clinical samples, rate of cross-infections, and rate of screening for CRKP carriage in patients at risk identified by rectal samples.
  
  
  RESULTS
  The incidence of CRKP decreased by 16-fold (P < .001), and this decrease was sustained for 30 months. The rate of cross-infection decreased from 6% during 2007-2008 to 2.7% in 2009-2010 (P < .05). This period saw an increased rate of active surveillance for carriers, from 20% to 89%.
  
  
  CONCLUSIONS
  A comprehensive infection control program can contain an outbreak of the CRKP KPC-3 strain in acute care hospitals during a nationwide outbreak of this strain.
authors.affiliation: Infectious Diseases Unit, Kaplan Medical Center, Rehovot, Israel. Electronic address: pnina.ciobotaro@gmail.com.
authors.forename: Pnina
authors.initials: P
authors.lastname: Ciobotaro
authors.affiliation: Infectious Diseases Unit, Kaplan Medical Center, Rehovot, Israel.
authors.forename: Maly
authors.initials: M
authors.lastname: Oved
authors.affiliation: Infectious Diseases Unit, Kaplan Medical Center, Rehovot, Israel.
authors.forename: Eyal
authors.initials: E
authors.lastname: Nadir
authors.affiliation: Microbiology Laboratory, Kaplan Medical Center, Rehovot, Israel.
authors.forename: Rita
authors.initials: R
authors.lastname: Bardenstein
authors.affiliation: Infectious Diseases Unit, Kaplan Medical Center, Rehovot, Israel.
authors.forename: Oren
authors.initials: O
authors.lastname: Zimhony
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D058872:Epidemics / Q000517:prevention & control; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D007557:Israel / Q000453:epidemiology; D007710:Klebsiella Infections / Q000453:epidemiology / Q000517:prevention & control*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D015397:Program Evaluation; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems