Interpretation of <i>Standard for Infection Prevention and Control of Carbapenem-resistant Enterobacterales</i>_West China Medical Journal

Authors：

QIAO Fu ^1,2 , CHEN Yi ² ,  ZONG Zhiyong ¹

1. Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZONG Zhiyong, Email: zongzhiy@scu.edu.cn

Keywords：

Carbapenem-resistant Enterobacterales; infection prevention and control; standard; interpretation

DOI：

10.7507/1002-0179.202402116

Video：

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In recent years, the prevalence of carbapenem-resistant Enterobacterales (CRE) has been remarkably increasing. Infections caused by CRE have significantly increased the burden on patients both medically and economically, and the CRE often leads to outbreaks of healthcare-associated infections. It has now become a global public health concern. Consequently, international organizations and academic societies/associations, including the World Health Organization, have developed corresponding prevention and control guidelines. This article provides a detailed introduction to the background, principles, key understandings, and implementation recommendations of China’s Standard for Prevention and Control of Carbapenem-resistant Enterobacterales (WS/T 826－2023). The aim is to enhance the recognition of healthcare workers and medical administrators to prevent and control CRE and to provide detailed technical guidance for healthcare facilities in responding to the spread of CRE, thus ensuring medical quality and patient safety.

Citation： QIAO Fu, CHEN Yi, ZONG Zhiyong. Interpretation of Standard for Infection Prevention and Control of Carbapenem-resistant Enterobacterales. West China Medical Journal, 2024, 39(3): 362-366. doi: 10.7507/1002-0179.202402116 Copy

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3.	World Health Organization. Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities. Geneva: World Health Organization, 2017.
4.	肖桂荣, 宗志勇. 从《遏制微生物耐药国家行动计划(2022-2025 年)》谈医疗机构抗微生物药物管理与微生物耐药防控. 华西医学, 2023, 38(3): 321-325.
5.	Campos-Madueno EI, Moradi M, Eddoubaji Y, et al. Intestinal colonization with multidrug-resistant Enterobacterales: screening, epidemiology, clinical impact, and strategies to decolonize carriers. Eur J Clin Microbiol Infect Dis, 2023, 42(3): 229-254.
6.	Halaby T, Al Naiemi N, Beishuizen B, et al. Impact of single room design on the spread of multi-drug resistant bacteria in an intensive care unit. Antimicrob Resist Infect Control, 2017, 6: 117.
7.	Janda JM, Abbott SL. The changing face of the family Enterobacteriaceae (Order: “Enterobacterales”): new members, taxonomic issues, geographic expansion, and new diseases and disease syndromes. Clin Microbiol Rev, 2021, 34(2): e00174-20.
8.	Qiao F, Wei L, Feng Y, et al. Handwashing sink contamination and carbapenem-resistant Klebsiella Infection in the intensive care unit: a prospective multicenter study. Clin Infect Dis, 2020, 71(Suppl 4): S379-S385.
9.	Kotsanas D, Wijesooriya WR, Korman TM, et al. “Down the drain”: carbapenem-resistant bacteria in intensive care unit patients and handwashing sinks. Med J Aust, 2013, 198(5): 267-269.
10.	Valentin AS, Santos SD, Goube F, et al. A prospective multicentre surveillance study to investigate the risk associated with contaminated sinks in the intensive care unit. Clin Microbiol Infect, 2021, 27(9): 1347. e9-1347. e14.
11.	Jamal AJ, Garcia-Jeldes F, Baqi M, et al. Infection prevention and control practices related to carbapenemase-producing Enterobacteriaceae (CPE) in acute-care hospitals in Ontario, Canada. Infect Control Hosp Epidemiol, 2019, 40(9): 1006-1012.
12.	Gestrich SA, Jencson AL, Cadnum JL, et al. A multicenter investigation to characterize the risk for pathogen transmission from healthcare facility sinks. Infect Control Hosp Epidemiol, 2018, 39(12): 1467-1469.
13.	Hota S, Hirji Z, Stockton K, et al. Outbreak of multidrug-resistant Pseudomonas aeruginosa colonization and infection secondary to imperfect intensive care unit room design. Infect Control Hosp Epidemiol, 2009, 30(1): 25-33.
14.	国家卫生和计划生育委员会规划与信息司, 中国医院协会医院建筑系统研究分会. 综合医院建筑设计规范: GB 51039-2014. 北京: 中国计划出版社, 2014.
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16.	Warnke P, Pappisch VR, Frickmann H, et al. Influence of bed making on loads of airborne and surface-associated drug-resistant bacteria in patient rooms. J Hosp Infect, 2023, 136: 45-54.
17.	Nelson NM, Aceto A, West GF. New patient privacy curtains to provide passive infection prevention. Infect Prev Pract, 2023, 5(3): 100291.
18.	Shek K, Patidar R, Kohja Z, et al. Rate of contamination of hospital privacy curtains on a burns and plastic surgery ward: a cross-sectional study. J Hosp Infect, 2017, 96(1): 54-58.
19.	Gomides MDA, Fontes AMS, Silveira AOSM, et al. The importance of active surveillance of carbapenem-resistant Enterobacterales (CRE) in colonization rates in critically ill patients. PLoS One, 2022, 17(1): e0262554.
20.	Guo B, Guo Z, Zhang H, et al. Prevalence and risk factors of carbapenem-resistant Enterobacterales positivity by active screening in intensive care units in the Henan Province of China: a multi-center cross-sectional study. Front Microbiol, 2022, 13: 894341.
21.	Chen X, Wen X, Jiang Z, et al. Prevalence and factors associated with carbapenem-resistant Enterobacterales (CRE) infection among hematological malignancies patients with CRE intestinal colonization. Ann Clin Microbiol Antimicrob, 2023, 22(1): 3.
22.	乔甫, 宗志勇. 世界卫生组织《医疗机构耐碳青霉烯的肠杆菌科细菌、铜绿假单胞菌和鲍曼不动杆菌防控指南》介绍. 华西医学, 2018, 33(3): 259-263.
23.	Reis MAO, de Almeida MCS, Escudero D, et al. Chlorhexidine gluconate bathing of adult patients in intensive care units in São Paulo, Brazil: impact on the incidence of healthcare-associated infection. Braz J Infect Dis, 2022, 26(1): 101666.
24.	Abboud CS, de Souza EE, Zandonadi EC, et al. Carbapenem-resistant Enterobacteriaceae on a cardiac surgery intensive care unit: successful measures for infection control. J Hosp Infect, 2016, 94(1): 60-64.
25.	Gall E, Long A, Hall KK. Chlorhexidine bathing strategies for multidrug-resistant organisms: a summary of recent evidence. J Patient Saf, 2020, 16(3S Suppl 1): S16-S22.
26.	Lee JH, Shin J, Park SH, et al. Role of probiotics in preventing carbapenem-resistant Enterobacteriaceae colonization in the intensive care unit: risk factors and microbiome analysis study. Microorganisms, 2023, 11(12): 2970.
27.	中华人民共和国国家卫生和计划生育委员会. 医疗机构环境表面清洁与消毒管理规范 WS/T 512-2016. 中国感染控制杂志, 2017, 16(4): 388-392.
28.	Liu HL, Liu YL, Sun FY, et al. Hand hygiene among anesthesiologists and microorganisms contamination in anesthesia environments: a single-center observational study. Biomed Environ Sci, 2022, 35(11): 992-1000.
29.	Friedman ND, Carmeli Y, Walton AL, et al. Carbapenem-resistant Enterobacteriaceae: a strategic roadmap for infection control. Infect Control Hosp Epidemiol, 2017, 38(5): 580-594.
30.	俞娟芬, 邢虎, 张德厚, 等. 多部门联合干预对重症监护病房多重耐药菌感染管理的效果研究. 中国消毒学杂志, 2022, 39(1): 58-61.
31.	余淑霞, 路宁维, 许婷, 等. 多部门协作联合干预 ICU 耐碳青霉烯类鲍氏不动杆菌医院感染聚集性病例的效果. 中华医院感染学杂志, 2022, 32(10): 1581-1585.
32.	林秀芳, 赖凌宇. 基于 MDT 与危急值管理在医院多重耐药菌医院感染中的应用. 中国卫生标准管理, 2023, 14(13): 169-173.
33.	莫元春, 李沃田, 杨文, 等. 危急值管理在多重耐药菌感染控制中的应用. 中华医院感染学杂志, 2019, 29(10): 1575-1578.

1. CHINET 数据云. 细菌分类年份统计. [2024-02-06]. http://www.chinets.com/Data/GermYear.
2. Huang W, Qiao F, Zhang Y, et al. In-hospital medical costs of infections caused by carbapenem-resistant Klebsiella pneumoniae. Clin Infect Dis, 2018, 67(Suppl_2): S225-S230.
3. World Health Organization. Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities. Geneva: World Health Organization, 2017.
4. 肖桂荣, 宗志勇. 从《遏制微生物耐药国家行动计划(2022-2025 年)》谈医疗机构抗微生物药物管理与微生物耐药防控. 华西医学, 2023, 38(3): 321-325.
5. Campos-Madueno EI, Moradi M, Eddoubaji Y, et al. Intestinal colonization with multidrug-resistant Enterobacterales: screening, epidemiology, clinical impact, and strategies to decolonize carriers. Eur J Clin Microbiol Infect Dis, 2023, 42(3): 229-254.
6. Halaby T, Al Naiemi N, Beishuizen B, et al. Impact of single room design on the spread of multi-drug resistant bacteria in an intensive care unit. Antimicrob Resist Infect Control, 2017, 6: 117.
7. Janda JM, Abbott SL. The changing face of the family Enterobacteriaceae (Order: “Enterobacterales”): new members, taxonomic issues, geographic expansion, and new diseases and disease syndromes. Clin Microbiol Rev, 2021, 34(2): e00174-20.
8. Qiao F, Wei L, Feng Y, et al. Handwashing sink contamination and carbapenem-resistant Klebsiella Infection in the intensive care unit: a prospective multicenter study. Clin Infect Dis, 2020, 71(Suppl 4): S379-S385.
9. Kotsanas D, Wijesooriya WR, Korman TM, et al. “Down the drain”: carbapenem-resistant bacteria in intensive care unit patients and handwashing sinks. Med J Aust, 2013, 198(5): 267-269.
10. Valentin AS, Santos SD, Goube F, et al. A prospective multicentre surveillance study to investigate the risk associated with contaminated sinks in the intensive care unit. Clin Microbiol Infect, 2021, 27(9): 1347. e9-1347. e14.
11. Jamal AJ, Garcia-Jeldes F, Baqi M, et al. Infection prevention and control practices related to carbapenemase-producing Enterobacteriaceae (CPE) in acute-care hospitals in Ontario, Canada. Infect Control Hosp Epidemiol, 2019, 40(9): 1006-1012.
12. Gestrich SA, Jencson AL, Cadnum JL, et al. A multicenter investigation to characterize the risk for pathogen transmission from healthcare facility sinks. Infect Control Hosp Epidemiol, 2018, 39(12): 1467-1469.
13. Hota S, Hirji Z, Stockton K, et al. Outbreak of multidrug-resistant Pseudomonas aeruginosa colonization and infection secondary to imperfect intensive care unit room design. Infect Control Hosp Epidemiol, 2009, 30(1): 25-33.
14. 国家卫生和计划生育委员会规划与信息司, 中国医院协会医院建筑系统研究分会. 综合医院建筑设计规范: GB 51039-2014. 北京: 中国计划出版社, 2014.
15. 重症监护病房医院感染预防与控制规范: WS/T 509-2016. 中国感染控制杂志, 2017, 16(2): 191-194.
16. Warnke P, Pappisch VR, Frickmann H, et al. Influence of bed making on loads of airborne and surface-associated drug-resistant bacteria in patient rooms. J Hosp Infect, 2023, 136: 45-54.
17. Nelson NM, Aceto A, West GF. New patient privacy curtains to provide passive infection prevention. Infect Prev Pract, 2023, 5(3): 100291.
18. Shek K, Patidar R, Kohja Z, et al. Rate of contamination of hospital privacy curtains on a burns and plastic surgery ward: a cross-sectional study. J Hosp Infect, 2017, 96(1): 54-58.
19. Gomides MDA, Fontes AMS, Silveira AOSM, et al. The importance of active surveillance of carbapenem-resistant Enterobacterales (CRE) in colonization rates in critically ill patients. PLoS One, 2022, 17(1): e0262554.
20. Guo B, Guo Z, Zhang H, et al. Prevalence and risk factors of carbapenem-resistant Enterobacterales positivity by active screening in intensive care units in the Henan Province of China: a multi-center cross-sectional study. Front Microbiol, 2022, 13: 894341.
21. Chen X, Wen X, Jiang Z, et al. Prevalence and factors associated with carbapenem-resistant Enterobacterales (CRE) infection among hematological malignancies patients with CRE intestinal colonization. Ann Clin Microbiol Antimicrob, 2023, 22(1): 3.
22. 乔甫, 宗志勇. 世界卫生组织《医疗机构耐碳青霉烯的肠杆菌科细菌、铜绿假单胞菌和鲍曼不动杆菌防控指南》介绍. 华西医学, 2018, 33(3): 259-263.
23. Reis MAO, de Almeida MCS, Escudero D, et al. Chlorhexidine gluconate bathing of adult patients in intensive care units in São Paulo, Brazil: impact on the incidence of healthcare-associated infection. Braz J Infect Dis, 2022, 26(1): 101666.
24. Abboud CS, de Souza EE, Zandonadi EC, et al. Carbapenem-resistant Enterobacteriaceae on a cardiac surgery intensive care unit: successful measures for infection control. J Hosp Infect, 2016, 94(1): 60-64.
25. Gall E, Long A, Hall KK. Chlorhexidine bathing strategies for multidrug-resistant organisms: a summary of recent evidence. J Patient Saf, 2020, 16(3S Suppl 1): S16-S22.
26. Lee JH, Shin J, Park SH, et al. Role of probiotics in preventing carbapenem-resistant Enterobacteriaceae colonization in the intensive care unit: risk factors and microbiome analysis study. Microorganisms, 2023, 11(12): 2970.
27. 中华人民共和国国家卫生和计划生育委员会. 医疗机构环境表面清洁与消毒管理规范 WS/T 512-2016. 中国感染控制杂志, 2017, 16(4): 388-392.
28. Liu HL, Liu YL, Sun FY, et al. Hand hygiene among anesthesiologists and microorganisms contamination in anesthesia environments: a single-center observational study. Biomed Environ Sci, 2022, 35(11): 992-1000.
29. Friedman ND, Carmeli Y, Walton AL, et al. Carbapenem-resistant Enterobacteriaceae: a strategic roadmap for infection control. Infect Control Hosp Epidemiol, 2017, 38(5): 580-594.
30. 俞娟芬, 邢虎, 张德厚, 等. 多部门联合干预对重症监护病房多重耐药菌感染管理的效果研究. 中国消毒学杂志, 2022, 39(1): 58-61.
31. 余淑霞, 路宁维, 许婷, 等. 多部门协作联合干预 ICU 耐碳青霉烯类鲍氏不动杆菌医院感染聚集性病例的效果. 中华医院感染学杂志, 2022, 32(10): 1581-1585.
32. 林秀芳, 赖凌宇. 基于 MDT 与危急值管理在医院多重耐药菌医院感染中的应用. 中国卫生标准管理, 2023, 14(13): 169-173.
33. 莫元春, 李沃田, 杨文, 等. 危急值管理在多重耐药菌感染控制中的应用. 中华医院感染学杂志, 2019, 29(10): 1575-1578.

West China Medical Journal

Interpretation of Standard for Infection Prevention and Control of Carbapenem-resistant Enterobacterales

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