Optimization of environmental surveillance-driven carbapenem-resistant organisms infection prevention and control strategies in intensive care units: A 4-year multicampus prospective intervention study

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BACKGROUND: Carbapenem-resistant organisms (CROs) are among the most concerning antimicrobial resistance pathogens, especially in intensive care units (ICUs). The role of environmental contamination in the transmission of CROs has been increasingly recognized. The aim of this study was to establish a replicable strategy on CROs' infection prevention and control (IPC) in ICUs. METHODS: This study was conducted in 4 phases. Environmental surveillance of CROs was conducted in ICUs every month to identify specific risks, and targeted IPC measures were implemented accordingly. Incidence rates of CRO-related healthcare-associated infections (HAIs) were calculated in each phase to assess the effectiveness of the IPC strategies. RESULTS: The detection of CROs in the ICU environment showed a downtrend during the study, with a significant decrease from 3.27% in baseline phase to 1.07% in phase III (P < .05). The detection of CROs in the open-bay ICU environment was significantly higher than that in the single-patient room ICU at baseline (3.97% vs 1.51%, P < .05) and became comparable in phase III after the implementation of our IPC strategies. The incidence of CRO-related HAIs per 1,000 ICU patient-days also decreased significantly from 2.333 in the baseline phase to 1.143 in phase III (P < .001). CONCLUSIONS: Our environmental surveillance-driven CRO IPC strategies were associated with reductions in environmental CRO contamination and CRO-related HAIs in ICUs; however, the results were limited by unmeasured confounders and the quasi-experimental design.