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Table 2b. Comparing national IPC policies on CPPA

From: Infection prevention and control policies in hospitals and prevalence of highly resistant microorganisms: an international comparative study

 

EMC (Netherlands)

VGS (Austria)

KSK (Austria)

INMI (Italy)

ERU (Turkey)

TGH (Greece)

Prevalence according to ECDC maps 2015 and CAESAR 2016 (13, 14)

3.7%

12.2%

12.2%

23.0%

32%

40%

Low

Medium

Medium

Medium

High

High

Median self-reported prevalence of HRMO per hospital per year, regardless of sample site (range 2014–2016)

20 (13–29)

5 (0–17)

13 (0–16)

23 (17–31)

467 (378–557)

52 (43–61)

Targeted screening§

      

 Primary case¥ - targeted screening on hospitalized patients

Yes (> 90%)*

Yes (> 90%)

Yes (> 90%)

Yes (50–90%)

Yes (> 90%)

No

 Primary case - targeted screening on discharged patients

Yes (> 90%)

No

No

No

Yes (50–90%)

No

 Secondary case – targeted screening on hospitalized patients

Yes (> 90%)

Yes (> 90%)

Yes (> 90%)

Yes (> 90%)

Yes (50–90%)

No

 Secondary case – targeted screening on discharged patients

Yes (> 90%)

No

No

No

Yes (50–90%)

No

 Outbreak – targeted screening on hospitalized patients

Yes (> 90%)

Yes (> 90%)

Yes (> 90%)

Yes (> 90%)

Yes (50–90%)

No

 Outbreak – targeted screening on discharged patients

Yes (> 90%)

No

No

Yes (50–90%)

Yes (50–90%)

No

Labelling

      

 Isolation label for CPPA-positive patients

Yes (> 90%)

Yes (50–90%)

Yes, but without HRMO specification (50–90%)

Yes (> 90%)

Yes (> 90%)

Yes (50–90%)

 Number of negative cultures before lifting label

6, during one year

Upon discharge (but stays archived digitally)

N.D.

3

3, one week apart

2

Isolation measures

      

 Isolation in multi-bedroom with blocking of the beds

No

Yes (50–90%)

Yes (> 90%)

Yes (> 90%)

Yes (50–90%)

No

 Isolation in single bedroom without anteroom

Yes (> 90%)

Yes (> 90%)

No

No

Yes (50–90%)

No

 Isolation in single bedroom with anteroom

No

No

No

Yes (> 90%)

Yes (10–49%)

No

Personal protective equipment

      

 Non-sterile gloves

Yes (> 90%)

Yes (> 90%)

Yes (> 90%)

Yes (> 90%)

Yes (> 90%)

Yes (50–90%)

 Disposable gowns

Yes (> 90%)

Yes (> 90%)

Yes (> 90%)

Yes (> 90%)

Yes (> 90%)

No

 Caps

No

Yes (> 90%)

No

No

Yes (10–49%)

No

 (Surgical) masks

No

Yes (> 90%)

No

No

Yes (< 10%)

No

Laboratory (2017)

      

 Screening technique CPPA

Culture/PCR, after broth enrichment

Culture, directly from clinical sample

Culture/PCR, directly on clinical sample & culture, after broth enrichment

Culture, directly from clinical sample

N.A.

Culture, directly from clinical sample

 Starting molecular typing of CPPA

N = 2

 N > 2

 N > 2

In case of clinical or epidemiological need (cluster/ outbreak)

N.A.

N.A.

 Molecular typing method of CPPA

MLVA

N.A.

Molecular typing is outsourced

Molecular typing is outsourced (RAPD, NGS/WGS, MLST)

N.A.

N.A.

Cleaning and disinfection

      

 Replacing separation curtains after discharge

Yes

Yes

No

N.A.

Yes

No

 Disposables in the isolation room are discarded after discharge

Yes

Yes

No

Yes

Yes

Yes

  1. Remarkable differences between de hospitals are depicted in italic. * Mentioned percentage is the self-reported adherence to own IPC policy. § Taking preventive cultures of persons with increased risk of HRMO, because they have been in contact with a confirmed positive case. ¥ Definition primary/index case: The first indicated patient in whom a clinical or screening sample was unexpectedly positive for a certain HRMO. Definition secondary case: A patient with the same HRMO as the primary/index case and is linked in time and place to the primary/index case. Definition outbreak: Two or more similar HRMO cases linked in time and place. Abbreviations; ECDC: European Centre for Disease Prevention and Control. CAESAR: WHO Central Asian and Eastern European Surveillance of Antimicrobial Resistance. IPC: infection prevention and control. HRMO: Highly resistant microorganisms. CPPA: Carbapenemase-producing Pseudomonas aeruginosa. N.D.: No data. N.A: Not applicable. PCR: Polymerase chain reaction. MLVA: Multiple-locus variable number tandem-repeat analysis. LAMP: Loop-mediated isothermal amplification. RAPD: Random amplified polymorphic DNA. NGS: Next generation sequencing. WGS: Whole genome sequencing. MLST: Multi-locus sequence typing. EMC: Erasmus MC University Medical Centre in Rotterdam, The Netherlands. VGS: Vienna General Hospital in Vienna, Austria. KSK: Kardinal Schwarzenberg Klinikum in Salzburg, Austria. INMI: National Institute for Infectious Diseases ‘Lazzaro Spallanzani’ in Rome, Italy. ERU: Erciyes University in Kayseri, Turkey. TGH: Tzaneio General Hospital in Piraeus, Greece