title: A national intervention to prevent the spread of carbapenem-resistant Enterobacteriaceae in Israeli post-acute care hospitals.
abstract: OBJECTIVE
  Patients hospitalized in post-acute care hospitals (PACHs) constitute an important reservoir of antimicrobial-resistant bacteria. High carriage prevalence of carbapenem-resistant Enterobacteriaceae (CRE) has been observed among patients hospitalized in PACHs. The objective of the study is to describe the impact of a national infection control intervention on the prevalence of CRE in PACHs.
  
  
  METHODS
  A prospective cohort interventional study.
  
  
  METHODS
  Thirteen PACHs in Israel.
  
  
  METHODS
  A multifaceted intervention was initiated between 2008 and 2011 as part of a national program involving all Israeli healthcare facilities. The intervention has included (1) periodic on-site assessments of infection control policies and resources, using a score comprised of 16 elements; (2) assessment of risk factors for CRE colonization; (3) development of national guidelines for CRE control in PACHs involving active surveillance and contact isolation of carriers; and (4) 3 cross-sectional surveys of rectal carriage of CRE that were conducted in representative wards.
  
  
  RESULTS
  The infection control score increased from 6.8 to 14.0 (P < .001) over the course of the study period. A total of 3,516 patients were screened in the 3 surveys. Prevalence of carriage among those not known to be carriers decreased from 12.1% to 7.9% (P = .008). Overall carrier prevalence decreased from 16.8% to 12.5% (P = .013). Availability of alcohol-based hand rub, appropriate use of gloves, and a policy of CRE surveillance at admission to the hospital were independently associated with lower new carrier prevalence.
  
  
  CONCLUSIONS
  A nationwide infection control intervention was associated with enhanced infection control measures and a reduction in the prevalence of CRE in PACHs.
authors.affiliation: National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel.
authors.forename: Debby
authors.initials: D
authors.lastname: Ben-David
authors.forename: Samira
authors.initials: S
authors.lastname: Masarwa
authors.forename: Amos
authors.initials: A
authors.lastname: Adler
authors.forename: Hagit
authors.initials: H
authors.lastname: Mishali
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Carmeli
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Schwaber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015780:Carbapenems / Q000627:therapeutic use*; D003428:Cross Infection / Q000517:prevention & control*; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000517:prevention & control*; D005260:Female; D006760:Hospitalization; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007557:Israel; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D011446:Prospective Studies
chemical_list: D015780:Carbapenems