Implementing a toolkit for the prevention, management and control of carbapenemase-producing Enterobacteriaceae in English acute hospitals trusts: a qualitative evaluation

Abstract

Background Antimicrobial resistance is an increasing problem in hospitals world-wide. Following other countries, English hospitals experienced outbreaks of carbapenemase-producing Enterobacteriaceae (CPE), a bacterial infection commonly resistant to last resort antibiotics. One way to improve CPE prevention, management and control is the production of guidelines, such as the CPE toolkit published by Public Health England in December 2013. The aim of this research was to investigate the implementation of the CPE toolkit and to identify barriers and facilitators to inform future policies. Methods Acute hospital trusts (N = 12) were purposively sampled based on their self-assessed CPE colonisation rates and time point of introducing local CPE action plans. Following maximum variation sampling, 44 interviews with hospital staff were conducted between April and August 2017 using a semi-structured topic guide based on the Capability, Opportunity, Motivation and Behaviour Model and the Theoretical Domains Framework, covering areas of influences on behaviour. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Results The national CPE toolkit was widely disseminated within infection prevention and control teams (IPCT), but awareness was rare among other hospital staff. Local plans, developed by IPCTs referring to the CPE toolkit while considering local circumstances, were in place in all hospitals. Implementation barriers included: shortage of isolation facilities for CPE patients, time pressures, and competing demands. Facilitators were within hospital and across-hospital collaborations and knowledge sharing, availability of dedicated IPCTs, leadership support and prioritisation of CPE as an important concern. Participants using the CPE toolkit had mixed views, appreciating its readability and clarity about patient management, but voicing concerns about the lack of transparency on the level of evidence and the practicality of implementation. They recommended regular updates, additional clarifications, tailored information and implementation guidance. Conclusions There were problems with the awareness and implementation of the CPE toolkit and frontline staff saw room for improvement, identifying implementation barriers and facilitators. An updated CPE toolkit version should provide comprehensive and instructive guidance on evidence-based CPE prevention, management and control procedures and their implementation in a modular format with sections tailored to hospitals’ CPE status and to different staff groups.

Epidemiology and risk factors of rectal colonization of carbapenemase-producing Enterobacteriaceae among high-risk patients from ICU and HSCT wards in a university hospital

“…Screening for asymptomatic CPE colonization and implementing contact precautions will reduce patientto-patient transmission. Although evidence-based guidelines on prevention and control of CPE are available [20][21][22], CPE still remains as a severe challenge in health care settings, and more studies on appropriate countermeasures are required especially for high-risk patients from intensive care unit (ICU) and hematopoietic stem cell transplantation (HSCT) wards. This prospective observational study was aimed to investigate the prevalence and epidemiology of fecal carriage of CPE, the carbapenemase genotypes, and to identify the independent risk factors for the acquisition of CPE colonization in highrisk patients in ICU and HSCT wards from a university hospital in China.…”

Neonates with Maternal Colonization of Carbapenemase-Producing, Carbapenem-Resistant Enterobacteriaceae: A Mini-Review and a Suggested Guide for Preventing Neonatal Infection

“…Evidence-based guidelines for CP-CRE exist in different countries, including England [27,28], France [29], the United States of America [6], Australia [30] and Canada [31]. They provided generalized guidelines to minimize spread in healthcare facilities, as this is the main area where the spread is thought to occur.…”

Rectal and Tracheal Carriage of Carbapenemase Genes and Class 1 and 2 Integrons in Patients in Neurosurgery Intensive Care Unit

“…The colonization of CR-GNB and CRGs has led to the development of nosocomial infections, an increase in the bloodstream infections, and a four-fold increase in mortality rate [ 3 , 19 ]. It has been suggested that a solution to this problem could be based on compliance with infection control measures such as reducing contacts between patients in the ICU and the utilization of the one-patient–one-nurse approach, rapid diagnostic techniques, and optimization treatment schemes [ 20 , 21 , 22 , 23 ]. To our knowledge, in Russia, little is known about the MDR-GNB and CRG colonization rates in hospitalized patients or in the wider community.…”