Developing a multimodal strategy to decrease and/or limit the dissemination of carbapenem-resistant Enterobacterales (CRE) in public healthcare institutions in Colombia

National AMR Context

Colombia faces a significant AMR challenge with the widespread presence of carbapenem-resistant Enterobacterales (CRE), especially during the COVID-19 pandemic. The increase in CRE cases is exacerbated by the co-existence of multiple carbapenemase genes. The Colombian government has taken steps to mitigate AMR, including the National Antimicrobial Resistance Response Plan (NARRP) and operational guidelines for Healthcare-Associated Infections (HAIs) and Antimicrobial Stewardship Programmes (ASPs). However, a stronger focus on sustainable infection prevention and control strategies is necessary to curb the rising CRE rates in healthcare institutions.

Problem this project addresses

Carbapenem-resistant Enterobacterales (CRE) represent a severe threat to public health in Colombia, particularly in high-complexity healthcare institutions. The rise in CRE cases has strained healthcare resources and increased mortality associated with hospital-acquired infections. Current infection prevention efforts are limited by lack of resources, training, and standardised protocols in public hospitals, resulting in inconsistent practices that fail to effectively control CRE spread. This project will address these gaps by implementing a multimodal IPC programme to sustainably reduce CRE transmission.

Project overview

The project seeks to decrease CRE transmission through an Infection Prevention and Control (IPC) bundle in Intensive Care Units (ICUs). This approach combines educational programmes, standard operating procedures (SOPs) for IPC, screening for CRE, and regular monitoring. A qualitative study will examine implementation challenges, while an economic evaluation will assess the programme’s cost-effectiveness for healthcare systems.

“This project is a crucial step toward addressing the escalating threat of carbapenem-resistant Enterobacterales (CRE) in Colombia. By introducing a multimodal infection prevention and control strategy, we aim to provide sustainable and scalable solutions for reducing CRE transmission within Colombian public healthcare settings, thus contributing to broader AMR containment efforts.” Gloria Cristina Córdoba Currea, Senior Science Advisor at ICARS

Objectives:

1. Establish a baseline for CRE incidence in ICU patients at participating hospitals.
2. Implement an IPC bundle programme in ICUs to control CRE spread.
3. Drive behavior change in healthcare staff around IPC practices.
4. Identify barriers and facilitators to IPC bundle implementation.
5. Conduct a cost-effectiveness evaluation of the IPC bundle.
6. Provide evidence for national policy development on CRE control.

Solutions and outcomes

1. Reduced incidence of CRE infections and colonisation in ICU patients.
2. Improved adoption and sustainability of IPC bundle protocols in Colombian public hospitals.
3. Creation of an online training platform and a “Train-the-Trainer” program.
4. Evidence base for CRE control policy recommendations at the national level.
5. Empowerment of healthcare workers, with an emphasis on female staff, in IPC practices.