Some fascinating modelling from the CDC Vital Signs programme suggests that a co-ordinated, multi-facilitiy approach will be much more effective than each hospital doing its own prevention interventions.
The team first estimated the burden of key infections in the US: CRE, multi-resistant P. aeruginosa, invasive MRSA and CDI combined were responsible for 310,000 infections in 2011, which would increase 10% to 340,000 over 5 years. However, with an ‘aggressive’ national intervention, this could be reduced to below 200,000 by 2019. It would be a huge undertaking to implement and co-ordinate a national campaign in the US, where there is so much heterogeneity in the way that hospitals are structured and funded. But if anybody can do it, the CDC can!
More concerning was the modelling around CRE, which suggested that the prevalence of CRE in a theoretical network of 10 hospitals would increase to 12% within 5 years of introduction. Furthermore, whilst each hospital doing its own prevention interventions would help, moderating the rate of increase, a co-ordinated multi-facility approach would cause the prevalence of CRE to plateau at 2% (see Figure below).
Figure: Comparing the impact of a co-ordinated, multi-facilitiy approach with each hospital doing its own prevention interventions to control CRE
Here in the UK, the PHE Toolkit may be seen as a co-ordinated multi-facility approach. However, in reality, there is considerable variation in the way that the Toolkit is being applied across the UK in response to local prevalence, so there really is no co-ordinated multi-facility approach at this stage.
The message here is clear: failure to work together with a regional / national approach to address the threat of CRE will result in it becoming endemic in our patient population within a fairly short timeframe.