Residents colonised or infected with CRE who have risk factors for transmission or whose basic personal hygiene practices may be compromised by cognitive or functional impairment, are more likely to contaminate their environment. It is essential that residential care facilities engage with their Infection Prevention and Control Leads to ensure appropriate management occurs.

CRE is spread in a similar way to other MRO/MDROs

Ensure a risk assessment is performed prior to bed allocation and/or at admission

Contact precautions will be required for those residents with risk factors for transmission

Strict adherence to hand hygiene protocols must be followed

Keep the environment clean and dust-free at all times, and use a 2-step cleaning regimen if the resident is under contact precautions

Ensure liaison with the infection prevention and control practitioner or infectious diseases physician if the resident is admitted with CRE

Hand Hygiene

Proper hand hygiene is essential, and if the resident's cognitive state is impaired, employees caring for them must be responsible for this activity, especially after any toileting or contact with colonised/infected sites or devices.

Strict adherence to standard precautions is the recommended safe practice for all resident contact regardless of whether or not infection is present. 

Effective hand hygiene is the most important way to prevent the spread of CRE. 

Hand hygiene should be performed

When entering, or leaving the room

Before and after dressings

Before and after wearing gloves

The use of gloves does not replace the need for hand decontamination. Hand hygiene should be performed before and after glove use. 

Plain liquid soap is adequate for hand washing, and an antimicrobial handwash may be used before and after dressing wounds or if the resident is incontinent or has diarrhoea.

In the absence of sufficient or adequate hand washing facilities and where hands are not visibly contaminated, an antiseptic product formulated for use without water should be used for hand cleansing.

Contact with others

Visits and outings may occur without risk to family and friends in most cases when the resident does not have diarrhoea.

Family and friends must be reminded to wash hands frequently after contact with the resident or surfaces frequently used by the resident.