title: Carbapenem-resistant Enterobacteriaceae on a cardiac surgery intensive care unit: successful measures for infection control.
abstract: BACKGROUND
  Carbapenem-resistant Enterobacteriaceae (CRE) cause surgical site infections (SSIs) in intensive care units (ICUs). This study aimed to evaluate the impact of intervention and control measures to reduce CRE colonization and infection rates among patients in the ICU of a cardiac surgery hospital following a CRE outbreak.
  
  
  METHODS
  An observational study of the pre- and postintervention status of a cohort of colonized or infected patients in the postoperative adult cardiac surgery ICU was performed between April 2013 and December 2014. As well as the usual measures of screening and cohort nursing, the control measures were enhanced during the intervention period by providing alcohol gel at the bedside, daily bathing with no-rinse 2% chlorhexidine-impregnated wash cloths, and disinfection of surfaces around the patient three times per day.
  
  
  RESULTS
  The rates of CRE colonization (P<0.001), primary central-line-associated bloodstream infections (P<0.002) and SSIs (P< 0.003) decreased significantly during the postintervention period.
  
  
  CONCLUSIONS
  The implemented measures were effective in controlling colonization and infection with CRE in the cardiac surgery ICU.
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil. Electronic address: cely.saad@gmail.com.
authors.forename: C S
authors.initials: CS
authors.lastname: Abboud
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
authors.forename: E E
authors.initials: EE
authors.lastname: de Souza
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
authors.forename: E C
authors.initials: EC
authors.lastname: Zandonadi
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
authors.forename: L S
authors.initials: LS
authors.lastname: Borges
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
authors.forename: L
authors.initials: L
authors.lastname: Miglioli
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
authors.forename: F C
authors.initials: FC
authors.lastname: Monaco
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
authors.forename: V L
authors.initials: VL
authors.lastname: Barbosa
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
authors.forename: D
authors.initials: D
authors.lastname: Cortez
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
authors.forename: A C
authors.initials: AC
authors.lastname: Bianco
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
authors.forename: A
authors.initials: A
authors.lastname: Braz
authors.affiliation: Associação Fundo de Incentivo à Pesquisa, AFIP Medicina Diagnóstica, São Paulo, Brazil.
authors.forename: J
authors.initials: J
authors.lastname: Monteiro
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D004196:Disease Outbreaks; D004755:Enterobacteriaceae / Q000201:enzymology / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D013903:Thoracic Surgery; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
keywords: Carbapenem-resistant Enterobacteriaceae colonization; Intensive care infection; Intervention measures; Postsurgical infection