CREATE a Response

The "CREATE a Response" section of the CREATE website focuses on what to do after CRE is found or suspected to be a problem at a veterinary facility. Even a single case can be an issue! Below you will find some brief highlights, but for the most comprehensive information, please download our full length document (PDF).

• Animal Isolation
  • Animals with suspected or confirmed CRE should be isolated from general patient populations immediately.
  • CRE-positive patients should not be allowed to defecate in shared areas.

  • Employees that handle CRE positive patients should be highly aware of isolation protocols.

• Laboratory Confirmation
  • Clinicians should work with their diagnostic laboratory to ensure that phenotypic and/or genotypic confirmation of CRE isolates is performed.

  • CREATE Reference Lab at Penn Vet can do this if your laboratory is not equipped, able or willing.

• Public Health and Human Contact Notification

  • Depending on the jurisdiction and reporting requirements, a diagnostic laboratory may or may not report the isolation of CRE to public health officials.

  • Currently the risk of transmission of CRE from animals to people is not well understood.

  • Veterinary staff, owners, and any other individual that has interacted with a CRE positive animal has a right to know about the exposure.

• Enhance Infection Prevention

  • A veterinary facility should always have a strong infection prevention program in place, but a case of CRE in the facility should trigger additional messaging to staff.

  • Improve hand hygiene, PPE use and environmental cleaning & disinfection.

• Identify if There is Ongoing Transmission

  • Strategies such as contact tracing and point prevalence surveys can be used to evaluate if active spread is occurring within the facility.

  • Testing for subclinical carriage can be performed through the CREATE reference lab.

• Environmental Management and Reservoirs

  • Affected spaces should be cleared of patients and “terminally cleaned.”

  • CRE are easily killed with most commercial disinfectants provided the manufacturer’s instructions for use (MIFU) are followed.

  • Targeted surveillance of CRE has proven valuable in our facility to help identify both sources and issues with infection control strategies. The CREATE Reference Lab offers environmental screening cultures “at cost.”