Analysis of Strategies for Successful Identification, Reporting, and Prevention of Carbapenem-Resistant Enterobacteriaceae (CRE) in Acute Health Care Facilities in New York State

Background. In healthcare in the United States antimicrobial resistant bacteria are an immediate concern. Carbapenem-resistant Enterobacteriaceae (CRE) are a unique problem because of high attributable mortality and ability to spread quickly in healthcare facilities. CRE has been selected for surveillance and intervention programs in New York State (NYS) hospitals.;Methods. Several data collection and intervention strategies were developed as part of this project. Surveys included information on laboratory methodologies for meeting the CRE case definition in hospital microbiology laboratories and the prevention practices in the environment of care. Informational presentations were given to hospital representatives and a Technical Advisory Workgroup (TAW). Surveillance data reported to the National Healthcare Safety Network (NHSN) was analyzed. Site visits were conducted to observe CRE prevention at the facility level. Comparisons were made between reported data and data audited by Infection Preventionists from the New York State Department of Health (NYSDOH).;Results. New York State hosts a variety of laboratory methodologies for microbiology testing including both manual and automated methods. The hospitals reported challenges with maintaining the infection prevention practices recommended by the Centers for Disease Control and Prevention (CDC), including hand hygiene. A large burden of CRE was reported, approximately 3200 cases in 2013; the majority of these cases are from hospitals in the New York City area. Site visits identified challenges with interdepartmental communication and meeting practice recommendations. Eleven hundred and fifty-one (1,151) CRE laboratory reports were audited with 156 records (13.6%) determined to be unreported to NHSN and 53 records (4.6%) determined to be reported in error.;Discussion. Quantitative and qualitative results are used to identify educational needs for CRE reporting and the difficulty in accurate data reporting due to the variation in CRE definitions and challenges with communication. Errors in reporting were caused by a variety of reasons including lapses in surveillance and misinterpretation of the surveillance definition.;Conclusions. Educational initiatives to include microbiology laboratory staff, improvements in the use of laboratory information systems (LIS) to communicate with Infection Prevention (IP), and updated NHSN definitions should improve the accuracy and consistency of CRE reporting and prevention in NYS.