Healthcare Facilities: Information about CRE

Carbapenem-resistant Enterobacterales (CRE) are a serious threat to public health. Infections with CRE are difficult to treat and have been associated with mortality rates of up to 50% for hospitalized patients. Due to the movement of patients throughout the healthcare system, if CRE are a problem in one facility, then typically they are a problem in other facilities in the region as well.

Healthcare facilities should:

• Recognize these organisms as important to patient safety and adhere to public health guidance for CRE detection, tracking, and reporting.
• Ensure their clinical laboratory can accurately identify CRE and has a policy to immediately alert clinical and infection prevention staff when CRE are identified.
• Understand the local epidemiology of carbapenemase-producing CRE, including prevalence in the facility and in the region. If your laboratory does not perform testing for carbapenemases, talk to your HAI coordinator about getting isolates tested through the AR Laboratory Network.

• Ensure precautions are implemented for CRE colonized or infected patients. These include:
  • Whenever possible, place acute care patients currently or previously colonized or infected with CRE in a private room with a bathroom and dedicate noncritical equipment (e.g., stethoscope, blood pressure cuff) to CRE patients.  For resident placement in skilled nursing facilities, see Implementation of Personal Protective Equipment (PPE) in Nursing Homes to Prevent Spread of Novel or Targeted Multidrug-resistant Organisms (MDROs) and Frequently Asked Questions (FAQs) about Enhanced Barrier Precautions in Nursing Homes.
  • Have and enforce a policy for using gown and gloves when caring for patients with CRE.
  • Have and enforce policies for healthcare personnel hand hygiene before and after contact with patient or their environment, and increase emphasis on hand hygiene on a unit caring for a patient or resident with CRE.

• Healthcare personnel should follow standard hand hygiene practices, which include use of alcohol-based hand sanitizer or, if hands are visibly soiled, washing with soap and water.
• When a patient with an unusual type of carbapenemase-producing CRE is identified in your facility, work with public health to prevent spread, including following guidance to assess for ongoing transmission.

• Have a system to assess, at admission, if a patient has received medical care somewhere else, including other facilities or other countries. Screen patients who have had an overnight stay in a healthcare facility outside the United States in the prior 6 months for the presence of carbapenemase-producing CRE. Admission screening is available free of charge through the AR Lab Network. Contact your HAI coordinator for more information on accessing AR Lab Network testing.

• When transferring a patient or resident, require staff to notify the receiving facility about infection or colonization with CRE and other multidrug-resistant organisms.
• Support healthcare providers prescribing and using antibiotics appropriately.
• Participate in regional and facility-based prevention efforts designed to stop the transmission of these organisms.

Resources

• AR Laboratory Network
• Facility Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE) [PDF – 24 pages]
• Containment Strategy Guidelines
• Interim Guidance for a Public Health Response to Contain Novel or Targeted Multidrug-resistant Organisms (MDROs) [PDF – 16 pages]
• CDC Vital Signs: Containing Unusual Resistance
• Frequently Asked Questions and Example Verbal Scripts to Request Assent for Multidrug-Resistant Organism (MDRO) Screening [DOC – 40 KB]
• Toolkit: Responding to New Forms of Antibiotic Resistance [PDF – 2 pages]
• Carbapenem-Resistant Enterobacteriaceae (CRE) Control and Prevention Toolkit
• CRE Carbapenem-resistant Enterobacterales Handout [PDF – 2 pages]
• CRPA Carbapenem-resistant Pseudomonas aeruginosa Handout [PDF – 2 pages]
• CRAB Carbapenem-resistant Pseudomonas aeruginosa Handout [PDF – 2 pages]