An ongoing national intervention to contain the spread of carbapenem-resistant enterobacteriaceae

In 2007, the Israel Ministry of Health initiated a nationwide intervention aimed at containing the spread of carbapenem-resistant Enterobacteriaceae (CRE), primarily manifested by the rapid dissemination of a single clone of Klebsiella pneumoniae. Data were gathered from acute and long-term care facilities, and ward-based mandatory guidelines for carrier isolation, patient and staff cohorting, and active surveillance were issued. Guidelines were issued to the microbiology laboratories delineating procedures for identifying CRE and carbapenemase production. A protocol for ruling out continued carriage in known carriers was established. Compliance with national guidelines was overseen via site visits at healthcare facilities, routine reporting of carrier census and isolation status, and the establishment of a network of communications to facilitate reporting on identified carriage, contact tracing and screening, and outbreak investigations. During the intervention, nosocomial CRE acquisition in acute care declined from a monthly high of 55.5 to an annual low of 4.8 cases per 100,000 patient-days (P < .001).