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Infection prevention and control practices related to carbapenemase-producing Enterobacteriaceae (CPE) in acute-care hospitals in Ontario, Canada

Published online by Cambridge University Press:  27 June 2019

Alainna J. Jamal ,
Felipe Garcia-Jeldes ,
Mahin Baqi ,
Sergio Borgia ,
Jennie Johnstone ,
Kevin Katz ,
Philipp Kohler ,
Matthew P. Muller ,
Allison J. McGeer  and
for the CPE Investigators of the Toronto Invasive Bacterial Diseases Network
Alainna J. Jamal
Affiliation:
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada Department of Infection Control, Sinai Health System, Toronto, Ontario, Canada
Felipe Garcia-Jeldes
Affiliation:
Department of Infection Control, Sinai Health System, Toronto, Ontario, Canada
Mahin Baqi
Affiliation:
Department of Infection Prevention and Control, William Osler Health Center, Brampton, Ontario, Canada
Sergio Borgia
Affiliation:
Department of Infection Prevention and Control, William Osler Health Center, Brampton, Ontario, Canada
Jennie Johnstone
Affiliation:
Department of Infection Control, Sinai Health System, Toronto, Ontario, Canada Department of Infection Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada
Kevin Katz
Affiliation:
Department of Infection Prevention and Control, North York General Hospital, Toronto, Ontario, Canada
Philipp Kohler
Affiliation:
Department of Infection Control, Sinai Health System, Toronto, Ontario, Canada
Matthew P. Muller
Affiliation:
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada Department of Infection Prevention and Control, St Michael’s Hospital, Toronto, Ontario, Canada
Allison J. McGeer*
Affiliation:
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada Department of Infection Control, Sinai Health System, Toronto, Ontario, Canada
for the CPE Investigators of the Toronto Invasive Bacterial Diseases Network
Affiliation:
Other members of the CPE Investigators of the Toronto Invasive Bacterial Diseases Network: Huda Al-Morhi, MD, LifeLabs, Toronto, Ontario, Canada; David Richardson, MD, William Osler Health Center, Brampton, Ontario, Canada; Brenda Coleman, PhD, Susan Poutanen, MD, MPH, and Cheryl Volling, MD, Sinai Health System, Toronto, Ontario, Canada; Roberto Melano, PhD and Samir Patel, PhD, Public Health Ontario, Toronto, Ontario, Canada; Jeff Powis, MD, Toronto East Health Network, Ontario, Canada; Daniel Ricciuto, MD, Lakeridge Health, Oshawa, Ontario, Canada; Anu Rebbapragada, PhD, Dynacare, Toronto, Ontario, Canada; Alicia Sarabia, MD, Trillium Health Partners, Mississauga, Ontario, Canada; Andrew Simor, MD, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
*
Author for correspondence: Allison J. McGeer, Email: allison.mcgeer@sinaihealthsystem.ca
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Abstract

Objective:

To determine infection prevention and control (IPAC) practices for carbapenemase-producing Enterobacteriaceae (CPE), an emerging threat, at acute-care hospitals in Ontario, Canada.

Design:

A descriptive cross-sectional survey.

Methods:

We surveyed IPAC directors and managers at all acute-care hospitals in Ontario, Canada, to gather information on IPAC practices related to CPE, including admission screening, other patient screening, environmental testing, use of precautions to prevent transmission, and outbreak management.

Results:

Of 116 acute-care hospitals, 105 (91%) responded. Admission screening included patients previously colonized or infected with CPE (n = 64, 61%), patients recently hospitalized outside of Canada (Indian subcontinent, n = 62, 59%; other countries, n = 56, 53%), and patients recently hospitalized in Canada (n = 22, 21%). Fifty-one hospitals (49%) screened patients for colonization during an outbreak. Almost all hospitals (n = 101, 96%) used precautions to prevent transmission from patients with CPE colonization or infection; most hospitals (n = 54, 53%) continued precautions indefinitely. Few hospitals (n = 19, 18%) performed environmental cultures. Eight hospitals (8%) reported at least 1 outbreak, and 6 hospitals (6%) reported transmission from sink or shower drains to patients.

Conclusions:

Variability in practices may result from lack of evidence and challenges in updating guidelines as evidence emerges. A coordinated approach to slow the emergence of CPE should be considered in our population.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 9 , September 2019 , pp. 1006 - 1012
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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