Carbapenem-resistant Enterobacterales (CRE) Infection Control

Key points

  • Carbapenem-resistant Enterobacterales (CRE) can spread from one facility to the next.
  • Healthcare providers should follow these recommendations to reduce the risk of CRE infections in their facility.

Why it's important

Carbapenem-resistant Enterobacterales (CRE) infections are difficult to treat. These bacteria (germs) can cause outbreaks in healthcare settings and are threats to patient safety. As patients move through the healthcare system, CRE in one facility can lead to CRE in other facilities. Providers should adhere to public health guidance for detection, tracking and reporting of CRE.

Recommendation details

  • Ensure your clinical laboratory can identify CRE and immediately alert clinical and infection prevention staff if identified.
    • If your laboratory does not perform testing, talk to your health department's HAI coordinator about testing isolates through CDC's AR Laboratory Network.
  • Understand the epidemiology of CRE in your facility or region.
  • Implement targeted infection control measures for patients:
    • Isolation and Contact Precautions in acute care settings.
    • Enhanced Barrier Precautions or Isolation and Contact Precautions in nursing homes, depending on the situation.
  • Enforce policies for core infection control practices like hand hygiene, personal protective equipment and environmental cleaning. Remind healthcare personnel on the importance of adhering to these policies when caring for a patient with CRE.
  • Work with public health to prevent spread in your facility by assessing for ongoing transmission.
  • Assess patients at the time of admission for history of overnight hospitalization or an invasive procedure in another country in the last 6 months. Patients with this history should be screened and placed in pre-emptive isolation.
  • Require staff to notify the receiving facility about CRE infection or colonization and other multidrug-resistant organisms when transferring a patient.
  • Prescribe and use antibiotics appropriately.
  • Participate in regional and facility-based prevention efforts designed to stop the transmission of antimicrobial-resistant organisms.

  • Understand the prevalence or incidence of carbapenemase-producing CRE (CP-CRE) in your jurisdiction by performing some form of regional surveillance for these organisms.
  • Increase awareness among healthcare facilities of the regional prevalence of CP-CRE and prevention strategies and initiatives.
  • Provide a standardized form for facilities to use during patient transfers, especially between hospitals and long-term care facilities.
  • Include a range of facility types when developing regional CRE prevention projects.
  • Be a resource for healthcare facilities on appropriate infection prevention measures and antibiotic stewardship (the practice of measuring and improving how providers prescribe antibiotics and patients use them).