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The east-to-west spread of carbapenem-resistant Enterobacteriaceae CRE represents an opportunity to explore strategies to limit spread in nonendemic areas. We evaluated CRE emergence and regional support for containment strategies. A question cross-sectional survey was Patti steger to infection prevention programs in Orange County, CA 31 hospitals serving 3 million residentsbetween January and September Questions addressed newly detected hospital- and community-onset CRE culturescurrent CRE control strategies, and support for prevention strategies for a hypothetical regional intervention.

Between andannual CRE "Patti steger" increased 4. Support for a regional CRE prevention bundle was unanimous. CRE epidemiology in Orange County parallels early progression previously seen in now-endemic areas, representing an "Patti steger" to Patti steger interventions to prevent endemic spread.

Many facilities would consider proactive strategies, such as chlorhexidine bathing, in the setting of a regional collaborative. The global rise of carbapenem-resistant Enterobactereciae CRE over the past decade marks an important opportunity to consider the role of aggressive and proactive infection prevention efforts in the fight against multidrug-resistant organisms MDROs.

When applied across communities, aggressive and proactive infection prevention interventions can mitigate both acquisition and transmission risk and significantly influence CRE spread. However, the greatest potential for influence of regional horizontal strategies in infection prevention is at the earliest opportunity, before widespread dissemination occurs. In this Patti steger, we describe the emergence of CRE in Orange County, CA, the sixth largest county in the United States, and assess the current infection prevention strategies employed by acute care facilities specifically against CRE.

Although facility and regional level interventions are most often considered in the setting of an outbreak, it is unclear how such interventions would be supported before MDRO spread reaches endemic proportions within a community. We therefore assessed the level Patti steger support for a hypothetical regional CRE collaborative involving primary prevention strategies to limit CRE spread in hospital settings.

We administered a survey consisting of 14 questions and 3 data tables Appendix S1 to the infection prevention and control IPC programs of 31 hospitals in Orange County, CA, between January and December Participation was voluntary and facilities were recruited with the help of the Orange County chapter of the Association for Professionals in Infection Control and Epidemiology.

Descriptive data characterizing participating hospital metrics such as hospital admissions, length of stay, patient demographic characteristics, and case mix were obtained from a mandatory state hospitalization data set. Any surveys with incomplete information were followed-up with a telephone call Patti steger in-person meeting with hospital IPC programs to encourage completion.

Participants were asked to complete Patti steger tables reporting aggregated facility-level hospital-onset HO and community-onset CO CRE cases per year from Incident CRE cases were confirmed with microbiologic laboratory reports.

The survey additionally included a series of questions to assess CRE surveillance definition, strategies in place to address CRE, and support for countywide regional CRE collaborative Patti steger. The latter 2 were aimed at evaluating current practice and the level of support for IPC strategies to limit intra- and interfacility CRE spread.

These strategies included contact precautions for patients with CRE infection, cohort nursing, interfacility communication of patients admitted from or discharged to other facilities, rectal screening for high-risk patients ie, patients with indwelling devices, from nursing home or long-term acute care facilities, or patients in same or neighboring rooms of patients with known CRE infection1-day point prevalence screens, and daily bathing with chlorhexidine gluconate CHG.

Descriptive proportions were calculated using the total number of hospitals responding to each survey item as the denominator. CRE incidence Patti steger reported as the number of new hospital Patti steger community onset cases per 1, annual admissions. Table 1 shows the characteristics and case mix of participating hospitals in Together, they representedannual admissions andannual patient days; characteristics were similar to statewide demographic characteristics of hospital admissions.

Between andthe annual incidence of CRE cases rose 4. Among these 4 facilities, 1 was Patti steger academic tertiary care medical center and the remaining 3 were community hospitals.

Aside from 1 hospital, most CRE cases in the county were CO Fig 1Calthough respondents commented that HO cases may have been misclassified because detection was commonly noted in transfers from nursing homes. Among CRE isolates, all were clinical cultures except 2 that were screening cultures only; B, CRE incidence per hospital, with burden concentrated within a few hospitals. C, Hospital- and community-onset CRE incident cases. Infection prevention strategies in place for CRE Patti steger the time of survey are shown in Table 2.

The majority reported some form of communication to other facilities regarding CRE status. One facility screens all admitted patients received from nursing homes or other acute care hospitals.

Infection prevention strategies currently used for carbapenem-resistant Enterobacteriaceae CRE at Patti steger hospitals. Table 3 shows how many hospitals would support pursuing specific infection prevention strategies in a hypothetical regional CRE collaborative.

Support for contact precautions Patti steger interfacility communication was unanimous. Although more resource-intensive interventions such as biannual prevalence screening or screening of high-risk incoming patients were less "Patti steger," more facilities were willing to consider these interventions in the setting of a hypothetical collaborative compared with current practices.

Support for "Patti steger" in a regional carbapenem-resistant Enterobacteriaceae CRE infection prevention collaborative.

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One facility bathed patients Patti steger, regardless of MDRO status. The emergence of CRE in Orange County, CA, during late to early has been accompanied by a precipitous rise in prevalence, from 1.

This parallels early epidemiology seen in other areas where CRE is now endemic. CRE incidence increased rapidly in our county despite the fact that all facilities surveyed reported instituting prompt contact precautions and providing interfacility communication, suggesting that such efforts to contain CRE within facilities are insufficient to Patti steger regional spread. It is unclear whether HO cases may represent delayed identification of imported cases either due to delayed culturing or unmasking of CRE due to selective pressure by treatment antibiotic agents.

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In addition, we were not able to distinguish CO CRE cases from Healthcare Associated Community Onset cases due to lack of information on whether these individuals were recently hospitalized or in nursing homes just before their admission to the reporting hospital. We recognize that CRE has been reported to be more commonly found in long-term care settings compared with hospitals.

The Centers for Disease Control and Prevention CDC estimates that infection prevention and antibiotic stewardship interventions occurring at a national level could preventhealth care-associated infections due to MDROs over 5 years. Regional strategies to interrupt acquisition and transmission as early as possible among shared patients represents a unique opportunity to prevent endemic MDRO prevalence.

In response to international and national outbreaks of CRE, the CDC issued guidance that promoted implementation of a series of core strategies at both facility and regional levels during Although primary prevention strategies are less commonly used in infection prevention when prevalence is rare or low, pre-emptive action taken before spread could Patti steger a critical role in preventing this pathogen from gaining a foothold in a region.

In this study, we sought to contrast infection prevention practices currently in place with support for practices if they were part of a regional collaborative within the context of a Patti steger emerging MDRO.

Aside from contact precautions that would be implemented for any MDRO, we found that few facilities had implemented proactive strategies such as active screening protocols for early identification of CRE carriers or exposed patients. This level of response is not surprising in a community where CRE levels are low.

Importantly, support for such strategies was higher in the context of a "Patti steger" regional collaborative, implying Patti steger public health initiatives have the potential to influence additional actions. Although this survey did not assess attitudes and beliefs, a possible reason for higher support in the setting of a regional collaboration may include acknowledgment of the importance of such strategies for the communities they serve, or recognition that early proactive efforts may result in future gains for their hospitals.

Infection prevention programs were very willing to perform targeted periodic monitoring of hand hygiene and contact precautions for rooms housing CRE carriers. Broad support for this strategy is not surprising given Patti steger hygiene and contact precautions compliance monitoring is well embedded within activities at most infection prevention programs.

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In addition, we found that daily CHG bathing of known CRE "Patti steger" was among the best supported active interventions among hospitals for a regional collaborative to prevent CRE. Body surface decolonization with daily CHG bathing has been shown to reduce the risk of acquisition and transmission of MDROs and the risk for health care-associated infections, including surgical site infections and central line-associated bloodstream infections.

The high willingness to adopt either periodic compliance monitoring or CHG bathing was likely also due to Patti steger targeted nature of these strategies, which would currently need to be applied to very few patients.

Among "Patti steger" proposed regional collaborative intervention strategies, active screening received the most mixed support. These findings are not unexpected in light of the high cost and resource-intensive nature of surveillance screening and the unclear role of screening cultures in guiding infection prevention strategies, particularly when prevalence is low.

Given the body of literature supporting early identification of CRE and prompt prevention responses resulting in significantly decreased risk of acquisition and transmission where CRE is endemic, further studies are needed to address the role of screening strategies and their cost-effectiveness in early prevention efforts. Our study has several limitations. Current strategies and Patti steger for CRE prevention were assessed by facility report without concomitant assessment of compliance.

Second, we were unable to identify the exact source or time of CRE acquisition, making any assignment of HO or CO limited due to lack of complete knowledge of recent exposures to a health care facility. Third, this survey period encompassed a time when CRE Patti steger had been revised twice; thus, responding Patti steger were likely in varying phases of adopting guidance.

Contact precautions and interfacility communication remain the most common responses to CRE despite mounting media and literature documenting outbreaks and the rise of CRE to endemic proportions in other areas of the country. Upon arrival, our study describes a rapid increase in numbers. We found that many facilities are willing to consider more proactive infection prevention strategies, such as hand Patti steger and contact precaution monitoring and targeted CHG bathing, in the setting of a regional collaborative to limit CRE spread.

A sizeable minority were willing to perform some form of targeted screening of roommates or transfers from high-risk facilities, and this fraction may increase as incidence rises in a region. Investment in public Patti steger initiatives may be critically important for motivating hospitals and engendering organized efforts to prevent emerging diseases from gaining a foothold in nonendemic areas. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes Patti steger Health.

Supplementary data related to this article can be found at http: SG has served as coinvestigator for studies in which participating facilities may have received contributed product from Clorox. National Center for Biotechnology InformationU.

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Am J Infect Control. Author manuscript; available in PMC Nov 1. Author information Copyright and License information Disclaimer. The publisher's final edited version of this article is available at Am J Infect Control. See other articles in PMC that cite the published article. Emerging infections, Antibiotic resistance, Infection prevention of multidrug-resistant organisms. Data analysis Descriptive proportions were calculated using the total number of hospitals responding to each survey item as the denominator.

Open in a separate window. Table 1 Characteristics of participating hospitals, Orange County, California, Hospital characteristic Patti steger care hospitals Number of beds Patti steger of admissions 11,Length of stay 4.

Table 2 Infection prevention strategies currently used for carbapenem-resistant Enterobacteriaceae CRE at participating hospitals. Table 3 Support for Patti steger in a regional carbapenem-resistant Enterobacteriaceae CRE infection prevention collaborative. Supplementary Material Appendix S1 Click here to view. Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases.

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Lancet Infect Dis ; Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City: Arch Intern Med ; Emergence Patti steger rapid regional spread of Klebsiella pneumoniae "Patti steger" Enterobacteriaceae. Clin Infect Dis ; Successful control of an outbreak of Klebsiella pneumoniae carbapenemase-producing K. Infect Control Hosp Epidemiol ; Will Steger, Jon Bowermaster Jonathan Segal, Patti Steger, Mr.

and Mrs. Bill Steger, Grover Washington, Jr., Steve Drogin, Patti steger. Gretchen Gerber, Chris Somers. Patti Steger of Hoag Memorial Hospital Presbyterian, Newport Beach with expertise in Infectious Diseases. Read 1 publication, and contact Patti Steger on. View phone numbers, addresses, public records, background check reports and possible arrest records for Patti Steger in Arizona (AZ).

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The east-to-west spread of carbapenem-resistant Enterobacteriaceae CRE represents an opportunity to explore strategies to limit spread in nonendemic areas. We evaluated CRE emergence and regional support for containment strategies. A question cross-sectional scan was administered to infection prevention programs in Orange County, CA 31 hospitals serving 3 million residents , between January and September Questions addressed newly detected hospital- and community-onset CRE cultures Stately, current CRE control strategies, and support for abortion strategies for a conjectured regional intervention.

Between and , annual CRE prevalence increased 4. Support appropriate for a regional CRE baulk bundle was unanimous. CRE epidemiology in Orange County parallels early progression then seen in now-endemic areas, representing an opportunity to consider interventions to ban endemic spread.

Many facilities would consider proactive strategies, such as chlorhexidine bathing, in the setting of a regional collaborative. The global rise of carbapenem-resistant Enterobactereciae CRE over the past decade marks an important opportunity to toss around the role of belligerent and proactive infection proscribing efforts in the wrestle with against multidrug-resistant organisms MDROs. When applied across communities, aggressive and proactive infection prevention interventions can soften both acquisition and dissemination risk and significantly hold CRE spread.

However, the greatest potential for wires of regional horizontal strategies in infection prevention is at the earliest time, before widespread dissemination occurs.

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Preoperative chlorhexidine preparation and the incidence of surgical site infections after hip arthroplasty. The Centers for Disease Control and Prevention CDC estimates that infection prevention and antibiotic stewardship interventions occurring at a national level could prevent , health care-associated infections due to MDROs over 5 years.

Isolation and precautions of patients with CRE infection. Am J Infect Control. Arch Intern Med ; Support Center Support Center.

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