What are the guidelines for contact isolation and treatment of patients infected with Klebsiella (Klebsiella pneumoniae) in a healthcare setting?

Contact Isolation Guidelines for Klebsiella Pneumoniae

All patients colonized or infected with Klebsiella pneumoniae, particularly carbapenem-resistant or carbapenemase-producing strains, should be placed on contact precautions with isolation in a single room to reduce transmission risk. 1

Core Contact Isolation Measures

• Healthcare workers must wear gloves and gowns before entering the room of patients colonized or infected with Klebsiella pneumoniae and remove these promptly after care, followed by hand hygiene 1
• Implement hand hygiene education programs using alcohol-based hand rubs before and after all patient contacts, with soap and water when hands are visibly soiled 1, 2
• Isolate colonized and infected patients in single rooms whenever possible to reduce acquisition risk 1
• When single rooms are unavailable, cohort patients with the same multidrug-resistant Klebsiella pneumoniae strain in designated areas 1
• Consider cohorting staff to reduce transmission risk, particularly during outbreaks 1
• Use alert codes to promptly identify patients already known to be colonized at hospital/ward admission and implement pre-emptive contact precautions 1

Surveillance and Monitoring

• Establish a protocol to detect carbapenem resistance or carbapenemase production in Klebsiella species and immediately alert infection control staff 1
• Review microbiology records for the preceding 6-12 months to identify previously unrecognized cases 1
• Conduct point prevalence surveys in high-risk units (ICUs, units with previous cases, units with high antibiotic use) to identify additional colonized patients 1
• When a hospital-associated case is identified, perform active surveillance testing of patients with epidemiologic links to the case 1
• Consider weekly perirectal surveillance cultures in outbreak settings until no new cases are identified 1, 3
• Surveillance screening should focus on rectal or perirectal swabs, which yield higher detection rates than other body sites 1

Environmental Control Measures

• Implement regular environmental cleaning procedures using appropriate detergents or disinfectants 1
• Dedicate non-critical medical equipment (stethoscopes, blood pressure cuffs) for use on individual patients colonized or infected with Klebsiella pneumoniae 1
• Ensure shared equipment is properly disinfected between patient use 1
• Consider environmental sampling of surfaces that have been in contact with colonized or infected patients during outbreaks 1
• Monitor cleaning performance to ensure consistent environmental decontamination 1

Additional Control Strategies

• Implement an antimicrobial stewardship program to limit the use of specific antimicrobial agents based on patient case-mix 1
• Conduct educational programs to ensure healthcare workers understand the epidemiological importance of Klebsiella pneumoniae and effective control measures 1, 2
• Hold regular multidisciplinary meetings to implement interventions, review adherence, and provide feedback to staff 1, 2
• Consider daily bathing of patients with chlorhexidine soap or chlorhexidine-impregnated cloths as part of a multifaceted approach during outbreaks 1

Duration of Contact Precautions

• Maintain contact precautions for the entire duration of hospitalization for patients with carbapenem-resistant Klebsiella pneumoniae 1
• For other multidrug-resistant Klebsiella strains, evidence on when to discontinue contact precautions is limited 1

Clinical Importance and Rationale

• Colonization with Klebsiella pneumoniae significantly increases the risk of subsequent infection (adjusted odds ratio 4.01) 4
• Implementation of bundled interventions including contact precautions, patient screening, and chlorhexidine bathing has been shown to reduce Klebsiella colonization from 45.8% to 34.3% and decrease infection rates 5
• Transmission modeling suggests that a minimum hand hygiene compliance of 50% is necessary to control transmission, while the observed compliance in healthcare settings is often much lower (21%) 3

Common Pitfalls and Caveats

• Low compliance with contact precautions and hand hygiene (often below 50%) can significantly undermine control efforts 1, 3
• Failure to identify colonized patients through active surveillance can lead to undetected transmission 1, 4
• Inadequate communication when transferring patients between healthcare facilities can result in breaches of infection control 1
• Focusing solely on clinical cultures without active surveillance will miss many colonized patients who can serve as reservoirs for transmission 4, 5