Management of carbapenem-resistant Enterobacterales in a veterinary hospital environment utilizing surveillance with infection control and prevention measures

Abstract Background Our program was initiated to manage an unexpected increase in carbapenem-resistant Enterobacterales (CRE) contamination identified during routine environmental surveillance in the small animal intensive care unit (ICU) at The Ohio State University Veterinary Medical Center (VMC). Addressing CRE, an urgent public health threat, was critical to protect patients and veterinary personnel. Hypothesis/Objectives Design an active surveillance program to guide infection control and prevention (ICP) measures and successfully manage CRE in the VMC environment. Methods The VMC’s environmental surveillance program has conducted monthly surveillance since 2018 to identify pathogens, including CRE. In response to increased CRE contamination in September 2023, a CRE Response Plan Working Group developed and implemented a plan to control contamination and prevent disease transmission. Interventions included enhanced surveillance, strengthened ICP measures, updated CRE protocols, improved cleaning and disinfection, hand hygiene audits and education, ICP training, and a unified communication strategy. Results Weekly environmental surveillance identified 4 repeatedly CRE-contaminated surfaces: the covered outdoor run, the emergency room and ICU hallway floors, and the ICU medication preparation counter and CUBEX machine. One patient with a clinical CRE infection was managed without any further identified transmission. By January 2024, repeated CRE contamination was no longer detected in the VMC. Screening ICU patients for CRE fecal colonization identified a 1.9% prevalence. Conclusions and clinical importance Active environmental surveillance enabled early detection of increased CRE contamination which guided ICP measures, decreasing the risk of CRE transmission. We provide a framework for responding to nosocomial threats in veterinary hospital settings.