Johns Hopkins study shows coordinated effort can reduce CRE 75 percent

A simulation study conducted by the Johns Hopkins Bloomberg School of Public Health in Baltimore shows that a coordinated regional effort among hospitals can reduce carbapenem-resistant Enterobacteriaceae (CRE) infections by more than 75 percent in health care facilities.

The researchers applied the school’s Regional Healthcare Ecosystem Analyst simulation model to detailed patient-level data from more than 30 acute care and more than 70 long-term care Orange County, Calif., health care facilities.

They applied three simulated scenarios: no specific control measures, facility-level infection control efforts (uncoordinated control measures) and a coordinated regional effort. The coordinated effort averted at least 21 percent more cases than did the other measures.

Researchers found that without increased infection control approaches, CRE would become endemic in nearly all Orange County health care facilities within 10 years. However, implementing interventions from the Centers for Disease Control and Prevention’s (CDC's) CRE toolkit has the potential to cut its spread in half.

CRE is a group of pathogens resistant to most antibiotics, associated with high mortality and considered a rising emerging public health threat, the study says.

One report notes that CRE can contribute to death in up to 50 percent of patients who become infected, according to the CDC, Atlanta. Current approaches to infection control and prevention have not been adequate to prevent its spread.

The coordinated approach described in the study is that all health care facilities in a region would share CRE test results with each other and a central authority, explains lead author Bruce Y. Lee, M.D., associate professor of international health and director of operations research, International Vaccine Access Center, Bloomberg School of Public Health.

The central authority would then utilize the information to strategically target infection prevention measures in different facilities, such as enhanced surveillance/screening of patients being transferred from one facility to another. Facilities also would share with each other the types of infection control measures that they are implementing, Lee says.

While the amount of CRE transmission that occurs through the environment from furniture and other objects in patient rooms has not been fully quantified, it likely plays some role, he says.

“Enhanced environmental cleaning could be a component of a coordinated approach. For example, facilities would share with each other what type of environmental cleaning that they are doing,” he says.

The study, "The Potential Trajactory of Carbapenem-Resistant Enterobacteriaceae, an Emerging Threat to Health-Care Facilities, and the Impact of the Centers for Disease Control and Prevention Toolkit," was published on the American Journal of Epidemiology's website in February.