Efficacy of Active Rapid Molecular Screening and IPC Interventions on Carbapenem-Resistant Enterobacterales Infections in Emergency Intensive Care Units without Enough Single-Room Isolation

Abstract

Purpose

To investigate whether rapid active molecular screening and infection prevention and control (IPC) interventions can reduce colonization or infection with carbapenem-resistant Enterobacterales (CRE) in a general emergency intensive care unit (EICU) without enough single-room isolation.

Methods

The study was designed as a before-and-after quasi-experiment. Before the experimental period, the ward was rescheduled and the staff were trained. From May 2018 to April 2021, active screening was performed by seminested real-time fluorescent polymerase chain reaction (PCR) detection with rectal swabs from all patients on admission to the EICU, and the results were reported in 1 hour. Other IPC interventions including hand hygiene, contact precautions, patient isolation, environmental disinfection, environment surveillance, monitoring, auditing and feedback were conducted under strict supervision. The patients’ clinical characteristics were collected simultaneously.

Results

In this 3-year study, 630 patients were enrolled and 19.84% of the patients were initially colonized or infected with CRE as shown by active molecular screening. The average drug resistance ratio to carbapenem shown by clinical culture detection of Klebsiella pneumoniae (KPN) before the study was performed was 71.43% in EICU. The drug resistance ratio decreased significantly from 75%, 66.67% to 46.67% in the next 3 years (p<0.05) during which active screening and IPC interventions were strictly executed. While the ratio gaps between EICU and the whole hospital were narrowed from 22.81%, 21.11% to 4.64%. Patients with invasive devices, skin barrier damage, and the recent use of antibiotics on admission were found to have a higher risk of being colonized or infected with CRE (p<0.05).

Conclusion

Active rapid molecular screening and other IPC interventions may significantly reduce CRE nosocomial infections even in wards without enough single-room isolation. The key to reduce the spread of CRE in the EICU is the strict execution of IPC interventions by all medical staff and healthcare workers.

Keywords:

• carbapenem-resistant
• Enterobacterales
• active screening
• infection prevention and control intervention
• emergency intensive care unit
• nosocomial infection

Abbreviations

IPC, infection-prevention and control; CRE, carbapenem-resistant Enterobacterales; CR, carbapenem resistance; EICU, emergency intensive care unit; PCR, polymerase chain reaction; CDC, Centers for Disease Control; ESBL, extended spectrum beta-lactamase; CR-GNB, carbapenem-resistant gram-negative bacilli; CRAB, carbapenem-resistant Acinetobacter baumannii; CRPsA, carbapenem-resistant Pseudomonas aeruginosa; KPN, Klebsiella pneumoniae; CR-KP, carbapenem-resistant Klebsiella pneumoniae; CRF, case report form; PFGE, pulsed-field gel electrophoresis.

Data Sharing Statement

All data analysed during this study are provided in the original data file.

Ethics Approval and Informed Consent

This study was conducted complying with the Declaration of Helsinki. Ethical approval was obtained from Shanghai East Hospital (Tongji University School of Medicine) in April 2018. The approval No. is [2018] (07). All study participants and/or their immediate guardians signed a detailed informed consent form prior to the study enrollment.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The study was sponsored by the National Natural Science Foundation of China (grant number 81971990) and Shanghai Municipal Health Commission Clinical Research (20194Y0386).