Carbapenem-Resistant Enterobacteriaceae (CRE) Control and Prevention Toolkit


Many in health care are familiar with multiple-drug–resistant organisms (MDROs) such as methicillin-resistant Staphylococcus aureus (MRSA), but carbapenem-resistant Enterobacteriaceae (CRE) are less well known, in spite of their rapid emergence on a global level. 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. Accordingly, the focus of this toolkit is KPC control, and the term KPC will be used in this document rather than CRE. Although the KPC epidemic continues to evolve, there are still opportunities to develop interventions to control further spread of this MDRO.1

The toolkit is organized into six sections, and can be used either in its entirety, or by pulling out specific sections that meet your organization's needs. We expect that leaders in infectious disease and infection control, as well as those concerned with patient safety and performance improvement, may be users of this toolkit. For those familiar with leading change processes and implementing process changes, the first few sections may not be necessary; it is possible to move right to Section 3, Putting Your Intervention Into Practice, if you and your organization are at that point. 

Section 1, Assessing Your Readiness for Change, may be useful if you are concerned about your organization's ability to adopt new guidelines and/or change processes for any type of healthcare-associated infections (HAI) initiative. 

Section 2, Starting Your Project, will be useful in any situation where a task force or team is needed in order to carry out the project, and provides crucial guidance about integrating your team's efforts with existing infection control routines and practices. 

Next, Section 3, Putting Your Intervention Into Practice, may be useful in thinking through how to roll out the changes in policy and/or process. 

Section 4, Implementing Best Practices, provides many tools and strategies that can be used in educating staff about KPC and the need for greater vigilance. 

Section 5, Measuring the Impact of your Intervention, and Section 6, Implementing and Sustaining Your Intervention, provide tools and information for understanding how well the new processes are working and how to sustain the gains.

1. Additional resources for understanding the terms CRE and KPC can be found in the following reference: Currie, B. The emergence of carbapenemase-producing Enterobacteriaceae. Inf Dis Special Edition 2012;15:9-13.

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Page last reviewed April 2014
Page originally created March 2014
Internet Citation: Introduction. Content last reviewed April 2014. Agency for Healthcare Research and Quality, Rockville, MD.