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Table 4 Core infection prevention and control measures to minimize risk of spread of CRE within and between healthcare settings

From: Infection prevention and control measures and tools for the prevention of entry of carbapenem-resistant Enterobacteriaceae into healthcare settings: guidance from the European Centre for Disease Prevention and Control

Intervention (Evidence source) Comments on measure and implementation
Antimicrobial stewardship (SR) Healthcare settings should have a formally defined antimicrobial stewardship programme for assuring appropriate antimicrobial use [54]
Healthcare settings should have facility-specific treatment (and prophylaxis) recommendations, based on national guidelines and local microbial susceptibility, to assist with empiric antimicrobial selection [54]
Should be part of a multimodal, integrated programme, along with IPC
Environmental cleaning (SR) Responsibilities for environmental cleaning and equipment reprocessing must be well-defined and described in hospital internal procedures
Hospitals should review the processes for environmental cleaning and equipment reprocessing, follow instructions of manufacturers, and consider screening (or auditing) to ensure quality of processes
Equipment reprocessing (SR)
Faecal and medical waste management (EO) Adequate toilet facilities should be available for all patients
When patients are incontinent or have diarrhoea, bedpans or commodes may be indicated
Guidelines and processes (EO) Adherence to evidence-based guidelines, processes and pathways for the prevention of healthcare-associated infections (EO)
Hand hygiene (SR) There is evidence for the effectiveness of hand hygiene, as part of a multimodal strategy, for the reduction of transmission of MDROs [56,57,58]
Patients should be encouraged to perform hand hygiene, as suggested by WHO guidelines [58]
Infrastructure and capacity for patient accommodation (EO) Healthcare managers should ensure that the ward occupancy does not exceed the capacity for which it is designed [72]
Healthcare managers should ensure that infection prevention and control building recommendations are followed
Microbiological capacity (EO) Healthcare settings should have access to microbiology laboratories with capacity to detect CRE from both clinical and screening specimens
Healthcare settings should have systems in place to ensure that potentially significant results are communicated by the microbiology laboratory in a timely manner to the relevant staff in the healthcare setting
Should be part of a multimodal, integrated programme, along with IPC and antimicrobial stewardship
Staff education (SR) On-going education and training should be provided to all staff with patient contact, with specific reference to CRE
Staffing (EO) Staffing, appropriate skill level and workload of frontline healthcare workers must be adapted to acuity of care and the number of pool/agency nurses and physicians minimised [72]
Surveillance (EO) Routine surveillance of healthcare-associated infections
  1. SR Systematic review, EO Expert opinion
  2. (Please see Additional file 1: Supplementary Table S2 in the supplementary section, for a printable summary of these measures)