Management strategy and standardize practice to prevent the transmission of Carbapenem-Resistant Enterobacteriaceae (CRE): A case report.

1 Oct 2019 Research

Raji Baidya, Janith Lal Singh, Sachin Shakya, Bijesh Raj Ghimire, Sudip Shrestha, Microbiology Unit and Infection Control Unit, Nepal Cancer Hospital and Research Center Pvt. Ltd., Harisiddhi, Lalitpur, Nepal, 2016.


Objective: To describe the management strategy to prevent the spread of multidrug-resistant organisms (MDROs).

Background: The emergence and transmission of Carbapenem-resistant Enterobacteriaceae (CRE) represents a serious threat and concern. The infections caused by these organisms are associated with high mortality rates and poses risk of disease transmission. The dissemination risk factor is even higher in the under developed countries as infection prevention strategies are lesser known and hardly implemented. Nepal Cancer Hospital and Research Center Pvt. Ltd. (NCHRC) has actively initiated the effectual and functional approach to implement infection control activities in its facilities. In this case report, the authors reviewed a presentation of urinary tract infection of CRE Klebsiella pneumonia and infection prevention measurement implementation to prevent the spread of the organism at NCHRC.

Case summary: The clinical laboratory facilitated a timely notification as CRE Klebsiella pneumonia was identified from clinical specimen. The patient’s CRE status was disseminated to nursing department so that the appropriate infection prevention measures could be promptly implemented. A standardizedinfection prevention plan was prepared and Centers for Disease Control and Prevention (CDC) guidelines were followed for prevention of spread of disease. Patient was placed on contact precaution ina private room. Barrier protection that includes both gowning & gloving requirements was implemented. Hand hygiene practice was strengthened before and after patient contact, using chlorhexidine based alcohol hand-rub. Further, daily environmental cleaning of the room and itemsrelatedpatientwas performedto minimize the organism burden and avoid cross-contamination. Active surveillance culture was performed through rectal swab culture to identify unrecognized CRE colonization. Once CRE patient was discharged, terminal cleaning of the room was conducted through fumigation using US Environmental Protection Agency (EPA) registered disinfectant followed by environmental (air & surface) sampling of the room. Admission of other patient was allowed only after no pathogenic organism was reported on environmentalsamples.Conclusion: We highlighted the management strategy and standardized practice to prevent the spread of CRE.

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