Impact of periodic screening on hospital-acquired carbapenemase-producing Enterobacterales colonization: an...

Early detection through systematic screening is recommended to prevent nosocomial transmission of carbapenemase-producing Enterobacterales (CPE).

To assess the effectiveness of a screening programme by estimating the association between healthcare workers' adherence to automatic screening orders and the incidence rate of hospital-acquired CPE colonization/infection at the hospital departmental level.

An ecological observational study was conducted at Unidade Local de Saúde de São João, Porto, Portugal, using data from January 2023 to June 2024. The hospital implemented automatic screening orders in September 2022, targeting high-risk patients at admission and all inpatients every week. Rectal swabs were tested by PCR for the bla_VIM, bla_OXA-48, bla_KPC, bla_NDM, and bla_IMP genes. Data sources included screening logs, CPE cases (≥48 h post-admission) from epidemiological surveillance, and the administrative database for hospitalization patient-days. Monthly departmental adherence to screening and incidence rates were computed. Generalized Additive Models for Location, Scale, and Shape (GAMLSS) were used to model the association between adherence to screening and the incidence rate of hospital-acquired CPE colonization.

Across 33 departments, median monthly adherence to automated CPE screening was 90.0% (range 62.0-98.7%), with substantial inter- and intra-departmental variability. Each 1% increase in global adherence was associated with a 2.9% reduction in the incidence of hospital-acquired CPE (exp β = 0.971; 95% confidence interval: 0.953-0.983). Between-department differences in baseline incidence were marked, but the effect of adherence on incidence was consistent across departments.

Strengthening adherence to routine screening protocols reduces CPE transmission in healthcare settings.