Table 6.

Synopsis of 11 successful infection control studies for CPE infections in nonendemic and endemic settings

Reference	Study design	Health care setting and geographic region	Infection control measures		Outcome
			Baseline	Additional
Studies in regions where CPE are not endemic
110	Retrospective	36-bed ICU in a tertiary care hospital, Melbourne, Australia	1. Surveillance of culture results	1. Universal contact precautions in ICU	Decrease of CPE cases from 3 to 1 per month
			2. Standard precautions	2. Single-room isolation of CPE patients (all wards)
			3. Environmental cleaning	3. Restriction of carbapenem use
122	Retrospective	Abdominal surgery center, Paris, France	1. Active surveillance for ESBLs	1. Preemptive isolation of contact patients and newly admitted patients	Rapid control of the outbreak
			2. Isolation of CPE patients	2. Dedicated nursing staff
			3. Contact precautions	3. Limited transfer of CPE patients
			4. Environmental disinfection	4. Antibiotic restriction policy (imipenem)
			5. Active surveillance	5. Screening campaign targeting contact patients discharged from the hospital
43	Retrospective	7 hospitals, Paris, France	1. National early warning system for multiresistant isolates	1. Cohorting of CPE cases and contacts	Rapid control of the outbreak
			2. Active surveillance for ESBLs	2. Flagging of CPE cases
			3. Active screening of contact patients	3. Dedicated health care workers
			4. Evaluation of duodenoscope disinfection practices	4. Reinforcing hand hygiene and contact precautions
				5. Limited transfer of CPE cases and contacts
				6. Revision of duodenoscope disinfection procedure
Studies in regions of endemicity
127	Retrospective	10-bed ICU in a tertiary care hospital, New York, NY	1. Contact isolation of CPE patients	1. Active surveillance for CPE on admission to ICU and weekly thereafter	Incidence decreased from 9.7 ± 2.2 to 3.7 ± 1.6 CPE cases per 1,000 patient-days
			2. Environmental cleaning	2. ICU closure and disinfection
			3. Infection control supervising	3. Cohorting of CPE patients
			4. Active surveillance for vancomycin-resistant enterococci and carbapenem-resistant Acinetobacter	4. Dedicated nursing staff 5. Promotion of hand hygiene
176	Retrospective	20-bed surgical ICU in a tertiary care hospital, Miami, FL	No data	1. Point prevalence surveillance	Control of CPE spread
				2. Isolation and contact precautions for CPE patients
				3. Dedicated nursing staff
				4. Daily chlorhexidine baths on all patients
				5. Environmental cleaning after every shift and evaluation with environmental cultures
				6. Educational campaigns
177	Retrospective	70-bed long-term acute care hospital, Chicago, IL	1. Active surveillance on admission	1. Active surveillance cultures for CPE and point prevalence surveys during the intervention	Colonization prevalence of CPE decreased progressively, from 21% to 12, 6, 3, and 0%
			2. Baseline point prevalence surveillance	2. Isolation and contact precautions for CPE patients
				3. Preemptive isolation of high-risk patients
				4. Environmental cultures and enhanced environmental cleaning
				5. Daily chlorhexidine baths for all patients
				6. Educational campaign
83	Retrospective	Long-term acute care hospital, South Florida	No data	1. Active surveillance culture	Termination of the outbreak
				2. Point prevalence survey
				3. Isolation and contact precautions for CPE patients
				4. Dedicated nursing staff and equipment
106	Retrospective	Tertiary care hospital, Puerto Rico	No data	1. Contact precautions for CPE patients	Control of the outbreak
				2. Cohorting of CPE patients
				3. Dedicated nursing staff
				4. Hand hygiene audits
				5. ICU closure
				6. Restriction of broad-spectrum antibiotics
				7. Active surveillance on admission to high-risk units (ICU, diabetes ward) and weekly thereafter
15	Retrospective	Tertiary care hospital, Tel Hashomer, Israel	1. Contact precautions for CPE cases	1. Active surveillance on admission to ICU and in step-down units and weekly thereafter	Incidence decreased from 6.93 to 1.8 CPE cases per 10,000 patient-days
				2. In other departments, active surveillance of patients with epidemiologic links to CPE carriers
				3. Daily reporting of CPE cases to hospital manager and the national coordinator
53	Prospective intervention study	Tertiary care hospital, Rehovot, Israel	No data	1. Active surveillance on admission to ICU, in roommates of new CPE cases or carriers, and in patients at high risk for carriage	Incidence decreased from 8.2 to 0.5 CPE case per 10,000 patient-days
				2. Isolation-cohorting and contact precautions for CPE cases and carriers
				3. Dedicated nursing staff
				4. Environmental cleaning and disinfecting during hospital stay and after discharge
				5. Education and training to all medical staff members, patients, and caregivers
				6. Automatic warning system
234	Prospective intervention study	27 acute care hospitals, Israel	No data	1. Isolation-cohorting and contact precautions for CPE patients and carriers	Monthly incidence decreased from 55.5 to 11.7 CPE cases per 100,000 patient-days
				2. Dedicated nursing staff and equipment
				3. Mandatory reporting to public health authorities of every CPE case
				4. Establishment of Task Force on Antimicrobial Resistance and Infection Control