scholarly journals Duration of Colonization With Klebsiella pneumoniae Carbapenemase-Producing Bacteria at Long-Term Acute Care Hospitals in Chicago, Illinois

2016 ◽  
Vol 3 (4) ◽  
Author(s):  
Manon R. Haverkate ◽  
Shayna Weiner ◽  
Karen Lolans ◽  
Nicholas M. Moore ◽  
Robert A. Weinstein ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Median Duration ◽  
Acute Care Hospitals ◽  
Interval Censoring ◽  
Control Measures ◽  
Likelihood Method ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Patients At Risk

Abstract Background.  High prevalence of Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae has been reported in long-term acute care hospitals (LTACHs), in part because of frequent readmissions of colonized patients. Knowledge of the duration of colonization with KPC is essential to identify patients at risk of KPC colonization upon readmission and to make predictions on the effects of transmission control measures. Methods.  We analyzed data on surveillance isolates that were collected at 4 LTACHs in the Chicago region during a period of bundled interventions, to simultaneously estimate the duration of colonization during an LTACH admission and between LTACH (re)admissions. A maximum-likelihood method was used, taking interval-censoring into account. Results.  Eighty-three percent of patients remained colonized for at least 4 weeks, which was the median duration of LTACH stay. Between LTACH admissions, the median duration of colonization was 270 days (95% confidence interval, 91–∞). Conclusions.  Only 17% of LTACH patients lost colonization with KPC within 4 weeks. Approximately half of the KPC-positive patients were still carriers when readmitted after 9 months. Infection control practices should take prolonged carriage into account to limit transmission of KPCs in LTACHs.

scholarly journals Anatomic Sites of Patent Colonization and Environmental Contamination with Klebsiella pneumoniae Carbapenemase—Producing Enterobacteriaceae at Long-Term Acute Care Hospitals

2013 ◽  
Vol 34 (1) ◽  
pp. 56-61 ◽  
Author(s):  
Caroline J. Thurlow ◽  
Kavitha Prabaker ◽  
Michael Y. Lin ◽  
Karen Lolans ◽  
Robert A. Weinstein ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Environmental Contamination ◽  
Acute Care Hospitals ◽  
Anatomic Site ◽  
Cross Sectional ◽  
Mechanically Ventilated ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Skin Colonization

Objective.To determine anatomic sites of colonization in patients and to assess environmental contamination with Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae.Design, Setting, and Patients.We conducted a cross-sectional microbiologic survey of 33 patients and their environments at 6 long-term acute care hospitals (LTACHs) in metropolitan Chicago. Swab samples of anatomic sites and inanimate surfaces in patients' rooms and common areas were cultured. blaKPC was verified by polymerase chain reaction. Patient charts were reviewed for covariates known to be associated with colonization and environmental contamination.Results.Mean age was 66 years. Median length of stay prior to surveillance was 50 days. Thirty (91%) patients were mechanically ventilated, 32 (97%) were bedbound, and 27 (82%) had fecal incontinence. Of the 24 patients with KPC-producing Enterobacteriaceae recovered from 1 or more anatomic sites, 23 (96%) had KPC-producing Enterobacteriaceae detected at 1 or more skin sites. Skin colonization was more common in patients with positive rectal/stool swab cultures or positive clinical cultures (P <.001). Rectal/stool swab was the single most sensitive specimen for detecting KPC-producing Enterobacteriaceae colonization (sensitivity, 88%; 95% confidence interval [CI], 68%-97%); addition of inguinal skin swab culture resulted in detection of all colonized patients (sensitivity, 100%; 95% CI, 86%-100%). Only 2 (0.5%) of 371 environmental specimens grew KPC-producing Enterobacteriaceae.Conclusions.Culture of more than 1 anatomic site was required to detect all KPC-producing Enterobacteriaceae-colonized Patients. Skin colonization was common, but environmental contamination was rare. These results can guide development of multimodal interventions for control of KPC-producing Enterobacteriaceae in LTACHs.

scholarly journals The Importance of Long-term Acute Care Hospitals in the Regional Epidemiology of Klebsiella pneumoniae Carbapenemase–Producing Enterobacteriaceae

2013 ◽  
Vol 57 (9) ◽  
pp. 1246-1252 ◽  
Author(s):  
Michael Y. Lin ◽  
Rosie D. Lyles-Banks ◽  
Karen Lolans ◽  
David W. Hines ◽  
Joel B. Spear ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Klebsiella Pneumoniae Carbapenemase

scholarly journals Understanding Staff Perceptions about Klebsiella pneumoniae Carbapenemase–Producing Enterobacteriaceae Control Efforts in Chicago Long-Term Acute Care Hospitals

2014 ◽  
Vol 35 (4) ◽  
pp. 367-374 ◽  
Author(s):  
Rosie D. Lyles ◽  
Nicholas M. Moore ◽  
Shayna B. Weiner ◽  
Monica Sikka ◽  
Michael Y. Lin ◽  
...  
Keyword(s):  
Organizational Culture ◽  
Quality Improvement ◽  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Qualitative Interviews ◽  
Control Program ◽  
Acute Care Hospitals ◽  
Quality Improvement Initiative ◽  
Klebsiella Pneumoniae Carbapenemase

Objective.To identify differences in organizational culture and better understand motivators to implementation of abundle intervention to control Klebsiella pneumoniae carbapenemase–producing Enterobacteriaceae (KPC).Design.Mixed-methods study.Setting.Four long-term acute care hospitals (LTACHs) in Chicago.Participants.LTACH staff across 3 strata of employees (administration, midlevel management, and frontline clinical workers).Methods.Qualitative interviews or focus groups and completion of a quantitative questionnaire.Results.Eighty employees (frontline, 72.5%; midlevel, 17.5%; administration, 10%) completed surveys and participated in qualitative discussions in August 2012. Although 82.3% of respondents felt that quality improvement was a priority at their LTACH, there were statistically significant differences in organizational culture between staff strata, with administrative-level having higher organizational culture scores (ie, more favorable responses) than midlevel or frontline staff. When asked to rank the success of the KPC control program, mean response was 8.0 (95% confidence interval, 7.6–8.5), indicating a high level of agreement with the perception that the program was a success. Patient safety and personal safety were reported most often as personal motivators for intervention adherence. The most convergent theme related to prevention across groups was that proper hand hygiene is vital to prevention of KPC transmission.Conclusions.Despite differences in organizational culture across 3 strata of LTACH employees, the high degree of convergence in motivation, understanding, and beliefs related to implementation of a KPC control bundle suggests that all levels of staff may be able to align perspectives when faced with a key infection control problem and quality improvement initiative.

scholarly journals How Long-Term Acute Care Hospitals Can Play an Important Role in Controlling Carbapenem-Resistant Enterobacteriaceae in a Region: A Simulation Modeling Study

2020 ◽  
Author(s):  
Bruce Y Lee ◽  
Sarah M Bartsch ◽  
Michael Y Lin ◽  
Lindsey Asti ◽  
Joel Welling ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Control Measures ◽  
Metropolitan Region ◽  
Drug Resistant ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Typically, long-term acute care hospitals (LTACHs) have less experience in and incentives to implementing aggressive infection control for drug-resistant organisms such as carbapenem-resistant Enterobacteriaceae (CRE) than acute care hospitals. Decision makers need to understand how implementing control measures in LTACHs can impact CRE spread regionwide. Using our Chicago metropolitan region agent-based model to simulate CRE spread and control, we estimated that a prevention bundle in only LTACHs decreased prevalence by a relative 4.6%–17.1%, averted 1,090–2,795 new carriers, 273–722 infections and 37–87 deaths over 3 years and saved $30.5–$69.1 million, compared with no CRE control measures. When LTACHs and intensive care units intervened, prevalence decreased by a relative 21.2%. Adding LTACHs averted an additional 1,995 carriers, 513 infections, and 62 deaths, and saved $47.6 million beyond implementation in intensive care units alone. Thus, LTACHs may be more important than other acute care settings for controlling CRE, and regional efforts to control drug-resistant organisms should start with LTACHs as a centerpiece.

scholarly journals The Effectiveness of Routine Daily Chlorhexidine Gluconate Bathing in Reducing Klebsiella pneumoniae Carbapenemase–Producing Enterobacteriaceae Skin Burden among Long-Term Acute Care Hospital Patients

2014 ◽  
Vol 35 (4) ◽  
pp. 440-442 ◽  
Author(s):  
Michael Y. Lin ◽  
Karen Lolans ◽  
Donald W. Blom ◽  
Rosie D. Lyles ◽  
Shayna Weiner ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Chlorhexidine Gluconate ◽  
Care Hospital ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Hospital Patients ◽  
Skin Colonization

We evaluated the effectiveness of daily chlorhexidine gluconate (CHG) bathing in decreasing skin carriage of Klebsiella pneumoniae carbapenemase–producing Enterobacteriaceae (KPC) among long-term acute care hospital patients. CHG bathing reduced KPC skin colonization, particularly when CHG skin concentrations greater than or equal to 128 μg/mL were achieved.

scholarly journals Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae in a Network of Long-Term Acute Care Hospitals

2016 ◽  
pp. ciw856 ◽  
Author(s):  
Jennifer H. Han ◽  
Ellie J.C. Goldstein ◽  
Jacqueleen Wise ◽  
Warren B. Bilker ◽  
Pam Tolomeo ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Carbapenem Resistant
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