A survey of infection control strategies for carbapenem-resistant <i>Enterobacteriaceae</i> in Department of Veterans’ Affairs facilities

Ramanathan, Swetha; Suda, Katie J.; Fitzpatrick, Margaret A.; Guihan, Marylou; Goedken, Cassie Cunningham; Safdar, Nasia; Evans, Martin E.; Jones, Makoto; Pfeiffer, Christopher D.; Perencevich, Eli N.; Rubin, Michael; Evans, Charlesnika T.; Program, Queri Carriage

doi:10.1017/ice.2020.328

Cited by 3 publications

(5 citation statements)

References 7 publications

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“…VA guidelines required laboratories to use CLSI M100-S21 or higher, however antibiotic susceptibility testing was performed by each VA laboratory according to their protocol, which may not have been consistent across sites. An electronic survey of 161 Multidrug-resistant Organism (MDRO) Prevention Coordinators at 134 VA Medical Centers (VAMCs) between February 21 and April 30, 2018 found 20.9% of coordinators reported active screening for Carbapenem-resistant Enterobacterales (CRE) and carbapenemase-producing-CRE colonization at their site [ 16 ]. However, each VA may have variability in surveillance and reporting for CRE [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

“…An electronic survey of 161 Multidrug-resistant Organism (MDRO) Prevention Coordinators at 134 VA Medical Centers (VAMCs) between February 21 and April 30, 2018 found 20.9% of coordinators reported active screening for Carbapenem-resistant Enterobacterales (CRE) and carbapenemase-producing-CRE colonization at their site [ 16 ]. However, each VA may have variability in surveillance and reporting for CRE [ 16 ]. Only cultures identified as CRAB or CRPA were included in the analysis, and only the last culture per patient was included.…”

Section: Methodsmentioning

confidence: 99%

“…Comorbidities were identified by ICD-10-CM codes in the 365 days prior to a carbapenem-resistant culture and used to calculate the Charlson comorbidity index. Spinal cord injury and disorder (SCI/D) diagnoses were also identified as the VA serves many Veterans with SCI/D and this population is known to be at risk for MDROs [ 16 ]. Previous antibiotic exposures were defined as any antibiotic prescribed in the 90 days before the positive culture.…”

Section: Methodsmentioning

confidence: 99%

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Epidemiology and outcomes associated with carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Pseudomonas aeruginosa: a retrospective cohort study

et al. 2022

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Background Carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) are a growing threat. The objective of this study was to describe CRAB and CRPA epidemiology and identify factors associated with mortality and length of stay (LOS) post-culture. Methods This was a national retrospective cohort study of Veterans with CRAB or CRPA positive cultures from 2013 to 2018, conducted at Hines Veterans Affairs Hospital. Carbapenem resistance was defined as non-susceptibility to imipenem, meropenem and/or doripenem. Multivariable cluster adjusted regression models were fit to assess the association of post-culture LOS among inpatient and long-term care (LTC) and to identify factors associated with 90-day and 365-day mortality after positive CRAB and CRPA cultures. Results CRAB and CRPA were identified in 1,048 and 8,204 unique patients respectively, with 90-day mortality rates of 30.3% and 24.5% and inpatient post-LOS of 26 and 27 days. Positive blood cultures were associated with an increased odds of 90-day mortality compared to urine cultures in patients with CRAB (OR 6.98, 95% CI 3.55–13.73) and CRPA (OR 2.82, 95% CI 2.04–3.90). In patients with CRAB and CRPA blood cultures, higher Charlson score was associated with increased odds of 90-day mortality. In CRAB and CRPA, among patients from inpatient care settings, blood cultures were associated with a decreased LOS compared to urine cultures. Conclusions Positive blood cultures and more comorbidities were associated with higher odds for mortality in patients with CRAB and CRPA. Recognizing these factors would encourage clinicians to treat these patients in a timely manner to improve outcomes of patients infected with these organisms.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Epidemiology and outcomes associated with carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Pseudomonas aeruginosa: a retrospective cohort study

et al. 2022

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“…In a survey done in 2018, it was found that communication between facilities about Veterans who were colonized or infected with CP-CRE occurred only 38%-42% of the time when the individual was transferred from another VA facility. 10 Often, infection control interventions designed to prevent spread of MDROs are independently implemented by individual health care facilities without clear coordination with other facilities within a healthcare system that may care for the same patients. Efforts limited to a single facility do not account for the potential of inter-facility spread through movement of patients who are colonized or infected with these organisms.…”

Section: Discussionmentioning

confidence: 99%

“…12 And in another VA survey, 70% of facilities did not screen admissions for CP-CRE because they did not think they had a problem with these organisms. 10 Third and finally, because user may select from various email alert options, a potentially engaged user may not receive an alert for months in the event no patients are admitted locally with a qualifying history of the target pathogen (eg C. auris or CP-CRE), such that the optimal number of national weekly users is not yet well established.…”

Section: Discussionmentioning

confidence: 99%

Development and implementation of a nationwide multidrug-resistant organism tracking and alert system for Veterans Affairs medical centers

Pfeiffer,

Jones,

Klutts

et al. 2024

Infect. Control Hosp. Epidemiol.

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Objective: Develop and implement a system in the Veterans Health Administration (VA) to alert local medical center personnel in real time when an acute- or long-term care patient/resident is admitted to their facility with a history of colonization or infection with a multidrug-resistant organism (MDRO) previously identified at any VA facility across the nation. Methods: An algorithm was developed to extract clinical microbiology and local facility census data from the VA Corporate Data Warehouse initially targeting carbapenem-resistant Enterobacterales (CRE) and methicillin-resistant Staphylococcus aureus (MRSA). The algorithm was validated with chart review of CRE cases from 2010-2018, trialed and refined in 24 VA healthcare systems over two years, expanded to other MDROs and implemented nationwide on 4/2022 as “VA Bug Alert” (VABA). Use through 8/2023 was assessed. Results: VABA performed well for CRE with recall of 96.3%, precision of 99.8%, and F1 score of 98.0%. At the 24 trial sites, feedback was recorded for 1,011 admissions with a history of CRE (130), MRSA (814), or both (67). Among Infection Preventionists and MDRO Prevention Coordinators, 338 (33%) reported being previously unaware of the information, and of these, 271 (80%) reported they would not have otherwise known this information. By fourteen months after nationwide implementation, 113/130 (87%) VA healthcare systems had at least one VABA subscriber. Conclusions: A national system for alerting facilities in real-time of patients admitted with an MDRO history was successfully developed and implemented in VA. Next steps include understanding facilitators and barriers to use and coordination with non-VA facilities nationwide.

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Evaluation of carbapenem-resistant Enterobacteriaceae (CRE) guideline implementation in the Veterans Affairs Medical Centers using the consolidated framework for implementation research

Goedken

Guihan

Brown

et al. 2021

Implement Sci Commun

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Background Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing (CP) CRE are difficult to treat, resulting in high mortality in healthcare settings every year. The Veterans Health Administration (VHA) disseminated guidelines in 2015 and an updated directive in 2017 for control of CRE focused on laboratory testing, prevention, and management. The Consolidated Framework for Implementation Research (CFIR) framework was used to analyze qualitative interview data to identify contextual factors and best practices influencing implementation of the 2015 guidelines/2017 directive in VA Medical Centers (VAMCs). The overall goals were to determine CFIR constructs to target to improve CRE guideline/directive implementation and understand how CFIR, as a multi-level conceptual model, can be used to inform guideline implementation. Methods Semi-structured interviews were conducted at 29 VAMCs with staff involved in implementing CRE guidelines at their facility. Survey and VHA administrative data were used to identify geographically representative large and small VAMCs with varying levels of CRE incidence. Interviews addressed perceptions of guideline dissemination, laboratory testing, staff attitudes and training, patient education, and technology support. Participant responses were coded using a consensus-based mixed deductive-inductive approach guided by CFIR. A quantitative analysis comparing qualitative CFIR constructs and emergent codes to sites actively screening for CRE (vs. non-screening) and any (vs. no) CRE-positive cultures was conducted using Fisher’s exact test. Results Forty-three semi-structured interviews were conducted between October 2017 and August 2018 with laboratory staff (47%), Multi-Drug-Resistant Organism Program Coordinators (MPCs, 35%), infection preventionists (12%), and physicians (6%). Participants requested more standardized tools to promote effective communication (e.g., electronic screening). Participants also indicated that CRE-specific educational materials were needed for staff, patient, and family members. Quantitative analysis identified CRE screening or presence of CRE as being significantly associated with the following qualitative CFIR constructs: leadership engagement, relative priority, available resources, team communication, and access to knowledge and information. Conclusions Effective CRE identification, prevention, and treatment require ongoing collaboration between clinical, microbiology, infection prevention, antimicrobial stewardship, and infectious diseases specialists. Our results emphasize the importance of leadership’s role in promoting positive facility culture, including access to resources, improving communication, and facilitating successful implementation of the CRE guidelines.

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A survey of infection control strategies for carbapenem-resistant Enterobacteriaceae in Department of Veterans’ Affairs facilities

Cited by 3 publications

References 7 publications

Epidemiology and outcomes associated with carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Pseudomonas aeruginosa: a retrospective cohort study

Epidemiology and outcomes associated with carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Pseudomonas aeruginosa: a retrospective cohort study

Development and implementation of a nationwide multidrug-resistant organism tracking and alert system for Veterans Affairs medical centers

Evaluation of carbapenem-resistant Enterobacteriaceae (CRE) guideline implementation in the Veterans Affairs Medical Centers using the consolidated framework for implementation research

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