title: Isolation demand from carbapenemase-producing Enterobacteriaceae screening strategies based on a West London hospital network.
abstract: OBJECTIVE
  To estimate the isolation demands arising from high-risk specialty-based screening for carbapenemase-producing Enterobacteriaceae (CPE), and the potential fraction of CPE burden detected.
  
  
  METHODS
  Clinical specialty groups from three London hospitals were ranked by incidence of carbapenem resistance among Escherichia coli and Klebsiella spp. Contact precaution bed-days were estimated for three screening strategies: Strategy 1, 'circulation science and renal medicine'; Strategy 2, Strategy 1 plus 'specialist services'; and Strategy 3, Strategy 2 plus 'private patients'. Isolation bed occupancy rates and potential CPE detection rates were estimated.
  
  
  RESULTS
  Of 99,105 admissions to the three hospitals in Financial Year 2014/15, Strategies 1, 2 and 3 would have screened 4371 (4.4%), 7482 (7.6%), and 13,542 (13.7%) patients, respectively. The specialties' isolation bed occupancy rates varied between 3% and 696% depending on strategy, number of consecutive tests, and whether or not pre-emptive isolation had been applied. Expected detection rates of the potential CPE burden in the hospital network would have varied between 17.1% and 47.5%.
  
  
  CONCLUSIONS
  High-risk specialty-based screening has the potential to detect nearly half of the potential CPE burden, and would be more pragmatic than patient-level risk-factor-based screening. Pre-emptive isolation increases isolation requirements substantially. CPE screening strategies need to balance risk and resources.
authors.affiliation: Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK. Electronic address: v.vella@imperial.ac.uk.
authors.forename: V
authors.initials: V
authors.lastname: Vella
authors.affiliation: Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK; Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
authors.forename: L S P
authors.initials: LS
authors.lastname: Moore
authors.affiliation: Modelling and Economics Unit, Public Health England, London, UK.
authors.forename: J V
authors.initials: JV
authors.lastname: Robotham
authors.affiliation: Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
authors.forename: F
authors.initials: F
authors.lastname: Davies
authors.affiliation: Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK.
authors.forename: G J C
authors.initials: GJ
authors.lastname: Birgand
authors.affiliation: Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Otter
authors.affiliation: Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Brannigan
authors.affiliation: Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK; Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Dyakova
authors.affiliation: Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK.
authors.forename: G M
authors.initials: GM
authors.lastname: Knight
authors.affiliation: Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Mookerjee
authors.affiliation: Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK; Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
authors.forename: A H
authors.initials: AH
authors.lastname: Holmes
mesh_terms: D001426:Bacterial Proteins / Q000032:analysis*; D001431:Bacteriological Techniques / Q000379:methods*; D004755:Enterobacteriaceae / Q000201:enzymology* / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology*; D006761:Hospitals; D006801:Humans; D008131:London / Q000453:epidemiology; D008403:Mass Screening / Q000379:methods*; D001618:beta-Lactamases / Q000032:analysis*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase
keywords: Carbapenemase-producing Enterobacteriaceae; Detection rates; Hospital screening; Isolation capacity; Isolation demand