TABLE 1.
Incidence rate ratios for detection from screening swabs ≥2 days after admission (a proxy marker of acquisition) in CMFT for all CRE cases, CR E. coli cases, and CR K. pneumoniae cases, modeling the impact of the ward 3 and ward 4 closures and plumbing replacement on acquisition
| Location and perioda | All CRE (3,086 cases) |
CR E. coli (502 cases) |
CR K. pneumoniae (1,134 cases) |
|||
|---|---|---|---|---|---|---|
| IRR (95% CI) | P | IRR (95% CI) | P | IRR (95% CI) | P | |
| MHC | ||||||
| Week 3, 2010, to week 26, 2014 (period 1) | 0.61 (0.31–1.20) | 0.15 | 0.15 (0.04–0.67) | 0.012 | 0.19 (0.04–0.82) | 0.026 |
| Week 27, 2014, to week 39, 2015 (period 2; reference period) | 1.00 | 1.00 | 1.00 | |||
| Week 40, 2015, to week 2, 2016 (period 3; wards 3 and 4 closed) | ||||||
| Week 3, 2016, to week 52, 2016 (period 4) | 0.11 (0.05–0.22) | <0.001 | 0.02 (0.00–0.14) | <0.001 | 0.27 (0.09–0.78) | 0.015 |
| Other hospital locations | ||||||
| Week 3, 2010, to week 26, 2014 (period 1) | 2.85 (1.87–4.34) | <0.001 | 2.51 (1.57–4.03) | <0.001 | 0.75 (0.30–1.86) | 0.53 |
| Week 27, 2014, to week 39, 2015 (period 2; reference period) | 1.00 | 1.00 | 1.00 | |||
| Week 40, 2015, to week 2, 2016 (period 3) | 0.41 (0.26–0.63) | <0.001 | 1.12 (0.61–2.05) | 0.71 | 0.27 (0.17–0.42) | <0.001 |
| Week 3, 2016, to week 52, 2016 (period 4) | 0.49 (0.32–0.76) | 0.002 | 0.47 (0.31–0.71) | <0.001 | 0.47 (0.28–0.77) | 0.003 |
| MHC vs other location in reference period (period 2) | 1.69 (0.81–3.50) | 0.16 | 9.05 (3.98–20.55) | <0.001 | 0.45 (0.24–0.86) | 0.015 |
| Heterogeneity for reduction in MHC vs other location | ||||||
| Week 3, 2010, to week 26, 2014 (period 1) | <0.001 | 0.001 | 0.098 | |||
| Week 40, 2015, to week 2, 2016 (period 3) | ||||||
| Week 3, 2016, to week 52, 2016 (period 4) | <0.001 | 0.003 | 0.31 | |||
Four time periods were evaluated, as follows: period 1, prior to implementation of a systematic CPE rectal screening policy; period 2, implementation of a CPE rectal screening policy consistent with national guidance; period 3, closure of wards 3 and 4 and replacement of plumbing infrastructure; period 4, reopening of wards 3 and 4 to patient admissions. Period 2 was chosen as the reference period because of the change in screening policies between period 1 and period 2 (see Table S2 and Fig. S6 in the supplemental material), meaning that a greater incidence would be expected in period 2, due to more patients being screened every week. IRR, incidence rate ratio; CI, confidence interval.