Department of Health and Human Services Nevada Division of Public - - PowerPoint PPT Presentation

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Department of Health and Human Services Nevada Division of Public - - PowerPoint PPT Presentation

Oct 08, 2023 132 likes •458 views

Brian Sandoval Richard Whitley Governor Director State of Nevada Department of Health and Human Services Nevada Division of Public and Behavioral Health Carbapenem-resistant Enterobacteriacea (CRE) in Nevada Kimisha Causey, MPH HAI

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Helping People. It’s who we are and what we do. Helping People. It’s who we are and what we do.

Brian Sandoval Governor Richard Whitley Director

State of Nevada

Department of Health and Human Services

Nevada Division of Public and Behavioral Health

Carbapenem-resistant Enterobacteriacea (CRE) in Nevada

Kimisha Causey, MPH HAI Coordinator May 31, 2018

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Helping People. It’s who we are and what we do. Helping People. It’s who we are and what we do.

Objectives

  • Define Carbapenem-resistant Enterbacteriacea (CRE)
  • Review current cases in Nevada
  • Discuss Centers for Disease Control and Prevention

(CDC) CRE prevention education and isolation recommendations

  • Explain upcoming state reporting requirements and

current voluntary reporting

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Helping People. It’s who we are and what we do. Helping People. It’s who we are and what we do.

Objectives

  • Discuss Nevada State Public Health Lab

(NSPHL) mechanism testing

  • Discuss DPBH assistance
  • Infection Control Assessment and Response (ICAR) tool
  • Target Assess Prevent (TAP) assessment tool
  • Antimicrobial Resistance Regional Laboratory (ARLN)

Sentinel Lab Program

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Helping People. It’s who we are and what we do. Helping People. It’s who we are and what we do.

CRE Definition

  • General definition: Enterobacteriaceae that are

nonsusceptible (i.e., intermediate or resistant) to a carbapenem

  • Resistant to any carbapenem antimicrobial (i.e.,

minimum inhibitory concentrations of ≥4 mcg/ml for doripenem, meropenem, or imipenem OR ≥2 mcg/ml for ertapenem) OR

  • Documented to produce carbapenemase

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CRE Background

  • Carbapenem‐resistant organisms are becoming increasingly common in

Western region.

  • Of particular concern are those that produce a carbapenemase, an enzyme

that neutralizes carbapenem antibiotics, the antibiotics of last resort. Carbapenemases in Gram‐negative organisms include:

  • Klebsiella pneumoniae carbapenemase (KPC)
  • New Delhi metallo‐β‐lactamase (NDM)
  • Oxacillin‐hydrolyzing β‐lactamase‐48 (OXA‐48)
  • Verona integron‐encoded metallo‐β‐lactamase (VIM)
  • mipenem‐hydrolyzing β‐lactamase (IMP)
  • US Centers for Disease Control and Prevention (CDC) and regional

AR Lab Networks recommend public health action

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Current Cases

  • March - May 2018 in Las Vegas
  • 18 CRE cases
  • 10 Klebsiella pneumoniae
  • 1 Pseudomonas aeruginosa
  • 4 CRO Enterobacter cloacae complex
  • 1 K. pneumoniae & Enterobacter cloacae
  • 1 K. pneumonia & P. aeruginosa
  • 1 K. Pneumoniae, E. faecalis, & VRE

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Current Cases

  • 7 sputum
  • 6 urine
  • 2 blood
  • 1 sputum/blood
  • 1 wound drainage
  • 1 sputum/urine

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Current Cases

  • 5 Acute care
  • 5 Long term acute care
  • 4 Skilled nursing facilities
  • 1 Assisted living facility

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Current Cases

  • Washoe County 2018 Quarter 1
  • January
  • 3 CRE
  • 5 Carbapenem Resistant Pseudomonas

aeruginosa (CRPA)

  • February
  • 4 CRE
  • 2 CRPA
  • March
  • 2 CRE
  • 9 CRPA

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Current Cases

  • 14 Inpatient
  • 8 Outpatient
  • 2 ICU
  • 1 SNF

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Recommendations for Control of CRE

  • 1. Hand Hygiene (soap and water or alcohol based

hand rub)

  • 2. System in place to identify patients with a history
  • f CRE upon admission
  • 3. Empiric Contact Precautions
  • 4. Education and training for Healthcare Personnel
  • n the proper use of Contact Precaution
  • 5. Minimize device use (discontinue

devices when possible)

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Recommendations for Control of CRE

  • 6. Inter-facility Communication/ Identification of

CRE Patients at Admission

  • 7. Patient and Staff Cohorting
  • 8. Screening Contacts of CRE Patients
  • 9. Active Surveillance Testing

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Environmental Cleaning

In order to decrease the risk of transmission, facilities should:

  • Perform daily cleaning that include areas in close

proximity to the patient (e.g., bed rails, patient tray)

  • Terminal clean the rooms of CRE patients once

discharged

  • Monitor the cleaning process to ensure all surfaces

are adequately cleaned and disinfected

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Recommendations for Control of CRE

Proper Use of Contact Precautions Includes:

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Performing hand hygiene before donning a gown and gloves Donning gown and gloves before entering the affected patient’s room Removing the gown and gloves and performing hand hygiene prior to exiting the affected patient’s room

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Contact Precaution

  • Identify patients with CRE prior to admission
  • Place patients who are colonized or infected with

CRE on Contact Precautions

  • Ensure proper signage is posted for staff, visitors,

etc.

  • Ensure proper PPE is available before entering

patient room

  • Instruct visitors to visit the nurses station for

education

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Contact Precautions

  • Provide CP training and regular PPE competency

audits

  • No firm recommendation on when

to discontinue CP for infected or colonized patients

  • CRE colonization can be prolonged (> 6

months)

  • CDC states: "If surveillance cultures are used to

decide if a patient remains colonized, more than

  • ne culture should be collected to improve

sensitivity."

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State Reporting Requirements & Current Voluntary Reporting

  • CDC approved the addition of Carbapenemase Producing

Carbapenem-Resistant Enterobacteriaceae (CP-CRE) to the National Notifiable Diseases Surveillance System as

  • f January 2018
  • CP-CRE Enterobacter spp.
  • CP-CRE E. Coli
  • CP-CRE Klebsiella spp.
  • Nevada reporting is voluntary, state mandates for reporting

are in the process of being drafted

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State Reporting Requirements Current Voluntary Reporting

  • Voluntary State reporting
  • CRE
  • Fax reports to 702-486-0490
  • Patient Name, DOB, +labs
  • Mandatory State reporting will include:
  • Acinetobacter baumannii, carbapenem-resistant (CRAB)
  • Enterobacteriaceae, carbapenem-resistant (CRE)
  • Pseudomonas aeruginosa, carbapenem-resistant (CRPA)

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Nevada State Public Health Lab (NSPHL) Mechanism Testing

  • NSPHL provides shipping supplies
  • Test isolate for carbapenemase producing

(CP) mechanism

  • Any healthcare facility can submit isolates for

further testing to determine non CP-CRE vs CP- CRE

  • Contact the state HAI Program for supplies and

shipping information

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Sentinel Lab Program ARLN

  • Antibiotic Resistance Laboratory Network (ARLN) is

seeking laboratories in Nevada to serve as sentinel sites and voluntarily submit specific organisms for further testing and tracking at the Public Health Laboratories

  • Benefits
  • Access to advanced laboratory testing
  • Free shipping
  • Certificate of participation
  • Receipt of statewide multidrug-resistant organism reports

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Sentinel Lab Program ARLN

  • Submitting isolates to ARLN is for facilities that

have signed commitment letters and serve as sentinel labs for Washington State regional lab ONLY.

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Sentinel Lab Program ARLN

  • Sentinel labs submit the following isolate-types to West Regional

Antibiotic Antimicrobial Resistance Regional Laboratory (ARLN):

  • All carbapenem-resistant Acinetobacter species
  • E. coli and Klebsiella pneumoniae resistant to third-

generation cephalosporins (all, or only a subset, depending on volume)

  • All Candida auris
  • All Candida species, EXCEPT C. albicans, C.parapsilosis, C.

dubliniensis, C.lusitaniae, C.tropicalis, and C.krusei (For C. glabrata, submit all, or only a subset, depending on volume.)

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Sentinel Lab Program ARLN

  • ARLN will work with interested labs to develop a

submission strategy to ease burden on lab personnel

  • For more information contact
  • Sopheay

Hun, Washington State Department of Health

  • Sopheay.Hun@doh.wa.gov
  • ARLN@doh.wa.gov
  • (206) 418-5453

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Interfacility Transfer Form

  • Transfer Form

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DPBH Assistance

  • ICAR Assessment
  • TAP Assessment

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ICAR Assessment

Comprehensive tool used to assess overall infection control programs in:

  • 29 Acute Care Facilities
  • 18 Long-Term Care Facilities
  • 13 Outpatient Facilities

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TAP Assessment

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HAI Program Contact Information

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Kimisha Causey, MPH

T: (702) 486-3568 |F: (702) 486-0490|E: kcausey@health.nv.gov

Jessica Conner, MPH

T: (775) 684-5290|E: jconner@health.nv.gov

Adrian Forero

T: (702) 486-0482|E: aforero@health.nv.gov

Chidinma Njoku T: (702) 486-0403|E: cnjoku@health.nv.gov

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THANK YOU

  • Reporting facilities
  • Project ECHO
  • HealthInsight
  • DPBH Administration
  • HAI Program Staff

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References

"Community-wide Surveillance for Carbapenemase Producing Organisms (CPO) Statistical Report for Q1 2018.” Washoe County Health District, May 2018. “Facility Guidance for Control of Carbapenem-Resistant Enterobacteriaceae (CRE) .” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, Nov. 2018, www.cdc.gov/hai/organisms/cre/index.html. “The Targeted Assessment for Prevention (TAP) Strategy.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 18 May 2018, www.cdc.gov/hai/prevent/tap.html.

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