526. Significant Reduction of Hospital Onset Carbapenem-Resistant Enterobacteriaceae Utilizing Infection Prevention Strategies: It takes a Village!

Background Carbapenem-resistant Enterobacteriaceae (CRE) is a Gram-negative bacteria and is considered one of the major challenges in healthcare worldwide. CRE has a high mortality rate, and the majority produce carbapenemase enzymes, which can be easily spread to other bacteria and patients. An inner-city hospital had a substantial decrease in CRE associated infections/colonization after the implementation of a multi-disciplinary process championed by hospital leadership and Infection Prevention (IP). Methods A quasi-experimental study of patients with hospital-onset CRE-positive cultures over Thirty-eight months was conducted. The pre-intervention period was from January 2015 to July 2016 and the post intervention period was from August 2016 to February 2018. The intervention comprised of a CRE prevention and control (CPC) bundle. The bundle comprised of hand hygiene, strict contact precautions, appropriate surveillance cultures and the cleaning of a patient’s environment and equipment with bleach. Hospital leadership implemented the CPC bundle during daily huddles with IP and department leaders with real-time identification and resolution of any barriers. The diligence of cleaning and disinfection was monitored using a transparent, easily cleanable and environmentally stable solution that fluoresces when exposed to UV light. The solution was used to mark standardized high touch surfaces and shared equipment in CRE patient rooms prior to terminal cleaning. These surfaces were evaluated with a UV light and used as an opportunity to educate staff on common cleaning oversight. Results Prior to implementation of the CPC bundle, there were 24 cases of CRE with a baseline rate of 2.40. After introducing the CPC bundle, there were 8 cases of CRE with a rate of 0.83 (P = 0.006). The CPC bundle was associated with a reduction in CRE cases by 67%. Conclusion A hospital-wide approach between multiple departments is critical for the success of CRE prevention and control. This study provides further evidence that a multi-faceted approach to monitoring compliance with the CPC bundle can help reduce the transmission of CRE. This approach can decrease the burden on the healthcare system and improve patient outcomes. Disclosures All authors: No reported disclosures.