Carbapenem-Resistant Enterobacteriaceae (CRE) Control and Prevention Toolkit

Leaders in infectious disease and infection control, as well as those concerned with patient safety and performance improvement, can use this toolkit to develop interventions to control carbapenem-resistant Enterobacteriaceae (CRE). CRE are the result of a complex family of plasmid-borne resistance factors that circulate among Enterobacteriaceae. In the United States, the overwhelming majority of CRE cases are caused by the plasmid-borne Klebsiella pneumoniae carbapenemase (KPC) gene circulating among Enterobacteriaceae, mostly commonly among Klebsiella pneumoniae isolates. KPC-producing organisms have spread epidemically in the United States and around the world among hospitalized patients.


Prepared by:

Victoria A. Parker, Ed.M., D.B.A.
Caroline K. Logan, M.P.H.
Boston University School of Public Health
Boston, MA

Brian Currie, M.D., M.P.H.
Montefiore Medical Center
New York, NY

Contents

Introduction
Section 1. Assessing Your Readiness for Change
   1.1 Do Organization Members Understand Why New Infection Control Guidelines Are Needed?
   1.2 Is There Urgency To Implement a New KPC Prevention Strategy?
   1.3 Does Leadership Support This Effort?
   1.4 Establishing Ownership
   1.5 What Resources Will You Need?
   1.6 What If You Are Not Ready?
Section 2. Starting Your Project
   2.1 How Can You Set Up the Implementation Team for Success?
   2.2 What Needs To Change?
   2.3 How Should Goals and Plans for Change Be Developed?
   2.4 Checklist for Managing Change
Section 3. Putting Your Intervention Into Practice
   3.1 Understanding the Epidemiology of KPC and the Apparent Inability of Standard Procedures To Contain and Control KPC
   3.2 Detection of KPC Colonization
Section 4. Implementing Best Practices
   4.1 Collecting Patient Specimens
   4.2 Surveillance Strategies
Section 5. Measuring the Impact of Your Intervention
   5.1 Types of Outcome Measures
Section 6. Implementing and Sustaining Your Intervention
Section 7. Tools and Resources
 

Prepared for: The Agency for Healthcare Research and Quality (AHRQ) under Contract No. 290-2006-0012-l.

This document is in the public domain and may be used and reprinted without special permission. Citation of the source is appreciated.

Cover photo: Carbapenem-resistant Enterobacteriaceae, courtesy of Centers for Disease Control and Prevention, Atlanta, GA.

Page last reviewed April 2014
Internet Citation: Carbapenem-Resistant Enterobacteriaceae (CRE) Control and Prevention Toolkit. April 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/cretoolkit/index.html