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Table 6 Supplemental infection control and prevention measures for patients with CRE preliminarily positive or confirmed microbiological results

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
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
  1. SR Systematic review, EO Expert opinion
  2. aDIRECTIVE 2011/24/EU OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL of 9 March 2011 on the application of patients’ rights in cross-border healthcare [22]
  3. (Please see Additional file 1: Supplementary Table S4 in the supplementary section, for a printable summary of these measures)