Table 4.
Core infection prevention and control measures to minimize risk of spread of CRE within and between healthcare settings
| Intervention (Evidence source) | Comments on measure and implementation |
|---|---|
| Antimicrobial stewardship (SR) | ✓ Healthcare settings should have a formally defined antimicrobial stewardship programme for assuring appropriate antimicrobial use [54] ✓ Healthcare settings should have facility-specific treatment (and prophylaxis) recommendations, based on national guidelines and local microbial susceptibility, to assist with empiric antimicrobial selection [54] ✓ Should be part of a multimodal, integrated programme, along with IPC |
| Environmental cleaning (SR) | ✓ Responsibilities for environmental cleaning and equipment reprocessing must be well-defined and described in hospital internal procedures ✓ Hospitals should review the processes for environmental cleaning and equipment reprocessing, follow instructions of manufacturers, and consider screening (or auditing) to ensure quality of processes |
| Equipment reprocessing (SR) | |
| Faecal and medical waste management (EO) | ✓ Adequate toilet facilities should be available for all patients ✓ When patients are incontinent or have diarrhoea, bedpans or commodes may be indicated |
| Guidelines and processes (EO) | ✓ Adherence to evidence-based guidelines, processes and pathways for the prevention of healthcare-associated infections (EO) |
| Hand hygiene (SR) | ✓ There is evidence for the effectiveness of hand hygiene, as part of a multimodal strategy, for the reduction of transmission of MDROs [56–58] ✓ Patients should be encouraged to perform hand hygiene, as suggested by WHO guidelines [58] |
| Infrastructure and capacity for patient accommodation (EO) | ✓ Healthcare managers should ensure that the ward occupancy does not exceed the capacity for which it is designed [72] ✓ Healthcare managers should ensure that infection prevention and control building recommendations are followed |
| Microbiological capacity (EO) | ✓ Healthcare settings should have access to microbiology laboratories with capacity to detect CRE from both clinical and screening specimens ✓ Healthcare settings should have systems in place to ensure that potentially significant results are communicated by the microbiology laboratory in a timely manner to the relevant staff in the healthcare setting ✓ Should be part of a multimodal, integrated programme, along with IPC and antimicrobial stewardship |
| Staff education (SR) | ✓ On-going education and training should be provided to all staff with patient contact, with specific reference to CRE |
| Staffing (EO) | ✓ Staffing, appropriate skill level and workload of frontline healthcare workers must be adapted to acuity of care and the number of pool/agency nurses and physicians minimised [72] |
| Surveillance (EO) | ✓ Routine surveillance of healthcare-associated infections |
SR Systematic review, EO Expert opinion
(Please see Additional file 1: Supplementary Table S2 in the supplementary section, for a printable summary of these measures)