Audit and Feedback As a Tool to Increase Compliance with Carbapenemase-Producing Enterobacteriaceae (CPE) Screening and Decrease CPE Transmission in the Hospital

Objective: To increase compliance with carbapenemase-producing Enterobacteriaceae (CPE) screening through real-time audit and feedback in our hospital and decrease CPE transmissions. Design: A before-and-after trial, using active enhanced surveillance of CPE carriers. Setting: A 500-bed, secondary, university-affiliated hospital that serves a population of 450,000 in a northern district in Israel. Methods: The study was conducted during 2016-2019 and included patients who were admitted to the hospital and fulfilled CPE screening criteria upon admission and during prolonged hospitalizations. On January 1, 2017, the infection control team implemented a new strategy of real-time feedback toward compliance with in-hospital screening guidelines. Other infection control measurements were performed without interventions. The primary outcome was compliance with appropriate CPE screening. Secondary outcomes included CPE acquisition and compliance with hand hygiene and contact precaution practices. Data were analyzed to calculate differences between compliance with CPE screening during the study period and to test the correlation between contact precautions and hand hygiene practices according to compliance with CPE screening. Results: During the study period, 3,131 patients were eligible for CPE screening. We detected a statistically significant increase in compliance to CPE screening from 74% during 2017 to 92% in 2018 and 95% in 2019 (P < .0001 for both comparisons). We detected a decrease in CPE transmission from 12% in 2017 to 2% in 2019 (P < .0001). We did not find any correlation between other infection control interventions and CPE screening and acquisition. Conclusion: Audit and feedback can improve appropriate CPE screening and may reduce CPE transmission in the hospital.