Table 6 Supplemental infection control and prevention measures for patients with CRE preliminarily positive or confirmed microbiological results
Intervention (Evidence source) | Comments on measure and implementation |
|---|---|
Contact precautions (SR) | ✓ Contact precautions should be continued when patient is suspected positive or confirmed positive ✓ Contact precautions should be used for direct contact with patient or their immediate surroundings and/or surfaces ✓ En suite or bathrooms designated for use by known carriers, or commodes are strongly suggested for all patients on contact precautions for CRE |
Patient isolation or patient cohorting (SR) | ✓ When patients were previously pre-emptively isolated they should remain isolated if results of active screening are suspected positive or confirmed positive ✓ If not already isolated, the patient should be isolated upon receipt of suspected or confirmed positive microbiological result |
Case communication (SR) (Communication about microbiological results within healthcare settings) | ✓ Communication on patient/resident transfer within a healthcare setting ✓ Positive results should be communicated by the microbiology laboratory in a timely manner to the relevant staff ✓ Healthcare record flagging and use of patient administration IT system flagging if feasible within healthcare setting, regarding any positive microbiological information ✓ Consider including patient’s carriage or infection status for CRE as a separate diagnosis ✓ Positive microbiological data should be communicated in a timely fashion when patients are transferred between units |
Communication on patient/resident transfer between healthcare settings ✓ Transfer documentation must accompany patient/resident, with information about known carriage or infection status ✓ Consider including patient’s carriage for CRE as a separate diagnosis ✓ Positive microbiological data should be communicated in a timely fashion when patients are transferred between healthcare settings within regions, country and across borders ✓ The responsibility to notify the receiving healthcare setting of patient’s/resident’s relevant microbiological data rests with the referral healthcare setting ✓ Ensure communication by a responsible person of local current or recent clusters or outbreaks to the receiving institution when patients/residents are transferred | |
Communication on patient transfer between healthcare settings in different countries ✓ Transfer documentation must accompany patient, with information about patient’s carriage or infection status ✓ Consider including patient’s carriage or infection status for CRE as a separate diagnosis ✓ Recognise the importance of implementing the cross-border Directivea in preventing inter-country spread of CRE ✓ Ensure timely communication with receiving healthcare setting for all positive patient microbiological data ✓ Ensure that patient’s rights for personal data protection are secured when sharing patient data between healthcare settings1 | |
Active screening of contacts (SR) | ✓ Active screening of patients/residents who are epidemiologically linked to a known CRE carrier |
Nurse cohorting (SR) | ✓ While acknowledging existing limitations in staffing and other resources, cohorting or designated nursing staff is strongly suggested for the care of patients with CRE |
Enhanced environmental cleaning (EO) | ✓ Enhanced cleaning should be performed, especially for areas in close proximity to CRE carriers ✓ Terminal disinfection of rooms should be performed upon transfer or discharge of patients |
Bathing in antiseptic (SR) | ✓ Data mostly available from Gram-positive organisms; can be used as a horizontal approach for other MDROs [73] ✓ Due to lack of strong evidence, can be considered for use in difficult-to- control situations |