Overview

Health care-associated infections (HAI) are one of the most common adverse events in care delivery. A large proportion are caused by antibiotic resistant organisms. There is worldwide consensus that urgent action is needed to prevent and control the spread of antibiotic resistant organisms. Effective infection prevention and control (IPC) is the cornerstone of action to combat antimicrobial resistance. This is emphasized by the International Health Regulations (IHR), which identify effective IPC as a key strategy for dealing with public health threats of international concern.

Carbapenem-resistant gram-negative bacteria, namely, carbapenem-resistant Enterobacteriaceae (CRE), Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPsA), are an emerging cause of HAI that pose a significant threat to public health. These bacteria are difficult to treat due to high levels of antibiotic resistance and are associated with high mortality. They have the potential for widespread transmission of resistance via mobile genetic elements. For these reasons, it was agreed that a key priority should be the development of WHO guidelines to provide evidence-based recommendations for the early recognition of CRE-CRAB-CRPsA and specific required IPC practices and procedures to effectively prevent their occurrence and control their spread in acute health care facilities. These are the first ever global guidelines for the prevention and control of CRE-CRAB-CRPsA in health care facilities and they include eight recommendations distilled by the world’s leading experts from a review of the latest evidence. They are intended to support IPC improvement at the health care facility and national level, both in the public services and private sector.

Contents

• Acknowledgements
• Acronyms and abbreviations
• Glossary of terms
• Declarations of interest
• Executive summary
  • Introduction
  • Rationale for the development of CRE-CRAB-CRPsA guidelines
  • Objectives
  • Target audience
  • Methods
  • Recommendations
  • Guideline implementation
• 1. Background
  • 1.1. Epidemiology and burden of disease of carbapenem-resistant Enterobacteriaceae (CRE), Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPsA)
  • 1.2. Rationale for developing recommendations to prevent and control colonization and/or infection with CRE-CRAB-CRPsA
  • 1.3. Scope and objectives of the guidelines
• 2. Methods
  • 2.1. WHO guidelines development process
  • 2.2. Evidence identification and retrieval
• 3. Evidence-based recommendations on measures for the prevention and control of CRE-CRAB-CRPsA
  • 3.1. Recommendation 1: Implementation of multimodal infection prevention and control strategies
  • 3.2. Recommendation 2: Importance of hand hygiene compliance for the control of CRE-CRAB-CRPsA
  • 3.3. Recommendation 3: Surveillance of CRE-CRAB-CRPsA infection and surveillance cultures for asymptomatic CRE colonization
  • 3.4. Recommendation 4: Contact precautions
  • 3.5. Recommendation 5: Patient isolation
  • 3.6. Recommendation 6: Environmental cleaning
  • 3.7. Recommendation 7: Surveillance cultures of the environment for CRE-CRAB-CRPsA colonization/contamination
  • 3.8. Recommendation 8: Monitoring, auditing and feeback
• 4. Guideline implementation and planned dissemination
  • Guideline implementation
  • Guideline dissemination
  • Evaluation of the recommendations
• References
• Appendix 1. External experts and WHO staff involved in preparation of the guidelines
• Appendix 2. Inventory of national and regional guidelines

Suggested citation:

Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.

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