Managing CRE Infections in LTC

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Carbapenem-resistant Enterobacteriaceae (CRE), a family of antibiotic-resistant bacteria including Klebsiella species and E Coli (Eschericha), are a normal part of the digestive system that can become Carbapenem-resistant.  CRE affects people in healthcare settings who have other conditions such as those on a ventilator, those that have catheters or IVs  and people taking long courses of antibiotics.

Long term care facilities can prevent and manage CRE infections by doing the following:

  • Isolate infected individuals or cohort them with individuals who are not immune-compromised and who are continent of bowel and bladder. It is not recommended to cohort an infected person with individuals who have an indwelling catheter, IVs, tracheostomy and wound drainage.
  • Use of Personal Protective Equipment (PPE), like gloves, gowns when cleaning-up body fluids, mask/eye/nose protection when splashing is anticipated for all staff coming in contact with the infected person.
  • All staff and the resident adhere to hand hygiene protocols before entering and leaving the resident’s room.
  • Special handling of linen.
  • Environmental cleaning and disinfection of resident’s room and equipment.
  • Timely communication of staff to let them know the resident is infected with a multidrug-resistant organism (MDRO) and to notify staff when the individual is being transported out of room.
  • For individuals who need therapy and have uncontrolled secretions and excretions, provide therapy in the resident’s room.  Use resident-dedicated equipment or single use equipment and clean-up immediately after use.  For therapy that cannot be done in the resident’s room, schedule therapy at the end of the day – last session and prior to transport notify staff, contain incontinence and wound drainage, and make sure all staff and resident clean hands prior to leaving the therapy room.   Also, use resident-dedicated equipment and clean equipment immediately after use.
  • Educate staff on MDROs, prevention and management.
  • For individuals visiting an infected person, ask them to wear a gown, gloves, and mask if splash anticipated and if providing care. Remind them to wash their hands when entering and leaving the room and to avoid visiting other patients.

The implication of CRE infection in LTC facilities requires monitoring antimicrobial use, minimizing the use of urinary catheters, and leaving catheters in place only as long as they are needed.  Caregivers need to be alert to signs and symptoms of possible CRE infection.  Providers are encouraged to use tools like the INTERACT Stop and Watch and Change in Condition File Cards to identify and communicate suspected symptoms and changes in condition.  For more information on CRE prevention, see the CDC (Centers for Disease Control & Prevention) Guidance for Control of Carbopenem-resistant or Ebterobacteriaceae.