- Ensure the laboratory rapidly notifies infection prevention and clinical staff when a patient or resident with CRO/CPO is identified.
- Consider tracking CRE LabID events using the NHSN MDRO module (PDF).
- Participate in the AR Lab Network Targeted Surveillance Program (PDF) to access confirmatory identification, antibiotic susceptibility and carbapenemase testing for CRPA and CRAB at no cost. Contact HAIProgram@cdph.ca.gov for more information.
- Know the local epidemiology and prevalence of CRO/CPO in your region.
- Understand patient risk factors and high-risk facilities for CRO/CPO in your jurisdiction, such as long-term acute care hospitals (LTACH) and ventilator-equipped skilled nursing facilities (vSNF).
- Work with local healthcare facilities to ensure awareness of CRO/CPO.
- Perform CPO colonization testing of patients and residents who are epidemiologically-linked to a patient newly identified with a CPO. Epi-linked patients include roommates, patients residing on the same unit, or patients exposed to the same medical device.
- Consider performing CPO colonization testing upon admission of high-risk patients. High-risk patients include those admitted from LTACH or vSNF, or have received healthcare outside the United States during the prior 12 months.
- Access CPO colonization testing services free of charge using the AR Lab Network. To learn more, contact the HAI Program to initiate a request.
- Use the CPO Screening Decision Tree (PDF) to guide colonization testing recommendations in healthcare facilities.
Infection Control Measures
- Place patients infected or colonized with CPO in a single room whenever possible, and implement Standard and Contact precautions; in skilled nursing facilities, if there is no evidence of transmission, place residents with risk factors for MDRO transmission on Enhanced Standard precautions.
- During an outbreak, consider requesting the facility provide documentation of their own adherence monitoring.
- Ensure thorough daily and terminal environmental cleaning. Focus on high-touch surfaces or any shared reusable medical equipment.
- Review environmental cleaning checklists available on the CDPH HAI Program website.
- Set expectations for facilities to communicate CRO/CPO status when transferring patients/residents to another healthcare facility.
- During an outbreak, consider requesting facilities notify public health of all discharges and transfers involving individuals with CRO/CPO.
Implement strategies to limit use of broad spectrum antimicrobial agents and an antimicrobial stewardship program (ASP) to promote and measure appropriate antimicrobial use by optimizing the selection, dosing, route, and duration of therapy.
Apply to be recognized as a top-performing ASP through the CDPH Antimicrobial Stewardship Honor Roll.
- Contact the HAI Program for any suspected and confirmed CRO/CPO outbreaks.
- Complete relevant investigation information in CalREDIE Lab and Epi Info tabs for CP-CRE and CPO (excluding CRE) conditions.