Evaluation of Infection Prevention Practices and Reporting of Carbapenem-Resistant Enterobacteriaceae (CRE) Among Long-Term Care Facilities in Suburban Cook County, IL

BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) are multidrug-resistant bacteria that pose clinical and infection control challenges in healthcare settings.  Infections with CRE have been associated with high rates of morbidity and mortality particularly among residents of long-term care facilities (LTCFs). Due to a steady increase in incident cases of CRE, the Illinois Department of Public Health (IDPH) established the Extremely Drug Resistant Organism (XDRO) Registry and mandated reporting of CRE by healthcare facilities in Illinois, effective November 2013. We sought to evaluate CRE awareness as well as infection prevention and reporting practices among LTCFs in suburban Cook County.

METHODS: An online survey was distributed to nursing directors of 147 LTCFs in November 2014.  The survey consisted of 23 questions. 

RESULTS: Forty-three (29%) of the 147 LTCFs contacted completed the survey. Not all respondents answered all questions. Among respondents, the frequency of CRE ranged from one case of CRE in 16 (37%) facilities, to more than 10 cases of CRE in 3 (7%) facilities. Two (67%) of the 3 facilities with >10 cases self-identified as long-term acute care hospitals (LTACHs).  Thirty-six (90%) facilities stated they knew CRE was a reportable condition. However, only twenty nine (71%) facilities were aware of the existence of the XDRO registry and 24 (59%) used the registry for reporting. Whereas fourteen (34%) facilities used the registry to look-up newly admitted patients to determine if they were previously positive for CRE, 15 (37%) facilities depended on medical records or notification by the transferring facility to determine a resident’s CRE status. Thirty-five (88%) facilities reported use of contact isolation precautions for CRE-infected residents compared to 17 (41%) facilities that placed CRE-colonized residents on contact precautions. Twenty-seven (6%) facilities educated CRE-colonized residents on hand hygiene and infection control procedures and allowed them to move freely throughout the facility, compared to 19 (48%) facilities that did the same for CRE-infected individuals. Nine (22%) facilities used no restrictions or isolation precautions for CRE-colonized individuals.

CONCLUSIONS: Despite high overall knowledge of CRE among LTCFs, many facilities were unaware of the existence of the XDRO Registry, and few utilized the registry for reporting of CRE. Prevalence of CRE was highest in LTACHs. Based on these findings, ongoing efforts of the Cook County Department of Public Health will focus on education of LTCF’s to improve reporting of CRE via the registry, and to reduce transmission by querying the registry for CRE status among newly admitted residents.