Developing Regionally Coordinated Infection Control Strategies for Carbapenem-Resistant and Carbapenemase-Producing Enterobacterales in Acute and Long-Term Care Hospitals: A Delphi Study

Background: Carbapenem-resistant Enterobacterales (CRE), particularly carbapenemaseproducing Enterobacterales (CPE), remain a major global public health concern.In Korea, reports from acute care hospitals (ACHs) have increased in absolute numbers, while those from long-term care hospitals (LTCHs) have risen both in numbers and in proportion.This Delphi study aimed to develop expert consensus to inform national CPE infection control policy by identifying key challenges, essential program components in ACHs and LTCHs, and strategies for regional coordination between healthcare facilities.Methods: A three-round Delphi study was conducted between October 2024 and February 2025 with 19 experts, including infectious disease physicians and infection control nurse leaders.The first round consisted of open-ended and multiple-choice questions to assess expert responses on the current practices and areas for improvement.Based on these responses, 85 items were rated on a 10-point Likert scale in the second and third rounds.Consensus was determined using content validity ratio, degree of convergence, and degree of consensus.Final strategies were then proposed by prioritizing items with the highest agreement and adapting them to the Korean healthcare context.Results: Of 85 items evaluated, 56 achieved consensus.