Hospital Admission Surveillance for CPE
The newly constructed, standalone, 40-bed LTACH opened in August 2010. Part of the University of Virginia (UVA) Health System, it is located 3.5 miles from the UVA Medical Center, a 600-bed acute care hospital. CPE surveillance records were reviewed for all patients at the LTACH from October 2010 through July 2012. Additional data were obtained from administrative databases and electronic medical records. The UVA Institutional Review Board approved this study with a waiver of consent.
CPE screening was initiated in October 2010 as a consequence of local experience with CPE and published observations that LTACHs serve as reservoirs of MDROs. All patients were screened via perirectal or ostomy swabs on admission. Weekly surveillance CPE cultures were performed on all patients in the facility. All patients with current or previous CPE colonization or infection were maintained under contact precautions.
Perirectal swabs were processed as described elsewhere. All Enterobacteriaceae isolates meeting criteria for production or possible production of extended-spectrum β-lactamases by automated testing (VITEK 2; bioMérieux) were phenotypically screened by the indirect carbapenemase test, as described elsewhere. All isolates with a positive CPE phenotypic test result underwent blaKPC polymerase chain reaction testing, as described elsewhere.
The rate of CPE colonization or infection among patients admitted from the affiliated acute care hospital was compared to that among patients admitted from regional hospitals by χ analysis, as modified by Campbell for small sample size, using SAS, version 9.2 (SAS Institute). The calculation was based on the number of admissions rather than individual patients, as readmissions represented new opportunities for acquisition of CPE.
Methods
Study Location and Design
The newly constructed, standalone, 40-bed LTACH opened in August 2010. Part of the University of Virginia (UVA) Health System, it is located 3.5 miles from the UVA Medical Center, a 600-bed acute care hospital. CPE surveillance records were reviewed for all patients at the LTACH from October 2010 through July 2012. Additional data were obtained from administrative databases and electronic medical records. The UVA Institutional Review Board approved this study with a waiver of consent.
CPE Surveillance and Infection Control Measures
CPE screening was initiated in October 2010 as a consequence of local experience with CPE and published observations that LTACHs serve as reservoirs of MDROs. All patients were screened via perirectal or ostomy swabs on admission. Weekly surveillance CPE cultures were performed on all patients in the facility. All patients with current or previous CPE colonization or infection were maintained under contact precautions.
Microbiology
Perirectal swabs were processed as described elsewhere. All Enterobacteriaceae isolates meeting criteria for production or possible production of extended-spectrum β-lactamases by automated testing (VITEK 2; bioMérieux) were phenotypically screened by the indirect carbapenemase test, as described elsewhere. All isolates with a positive CPE phenotypic test result underwent blaKPC polymerase chain reaction testing, as described elsewhere.
Statistical Methods
The rate of CPE colonization or infection among patients admitted from the affiliated acute care hospital was compared to that among patients admitted from regional hospitals by χ analysis, as modified by Campbell for small sample size, using SAS, version 9.2 (SAS Institute). The calculation was based on the number of admissions rather than individual patients, as readmissions represented new opportunities for acquisition of CPE.
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