# A patient is admitted with a urine culture positive for Klebsiella pneumoniae carbapenemase (KPC) — a carbapenem-resistant Enterobacteriaceae (CRE). Which infection prevention and control measures should the nurse implement? Select all that apply.

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> language: en  
> subject: Safety and Infection Prevention and Control  
> category: SIPC

## Question

A patient is admitted with a urine culture positive for Klebsiella pneumoniae carbapenemase (KPC) — a carbapenem-resistant Enterobacteriaceae (CRE). Which infection prevention and control measures should the nurse implement? Select all that apply.

1

Discontinue isolation as soon as the patient becomes asymptomatic, even if cultures remain positive.

2

Place the patient on contact precautions, including gown and gloves on every entry to the room.

3

Assign dedicated patient-care equipment (stethoscope, blood pressure cuff, thermometer) and label it for that patient only.

4

Use chlorhexidine-bathing protocols if available and perform meticulous hand hygiene before and after every patient contact, even with gloves.

5

Notify the infection prevention team and screen roommates and recent contacts per facility protocol.

## Explanation

CRE/KPC requires CONTACT precautions: gown + gloves on every entry, dedicated equipment, hand hygiene with soap and water or alcohol-based rub, often chlorhexidine bathing as part of MDRO bundles, and infection prevention notification with contact tracing. Choice 1 is wrong — CRE colonization and shedding can persist for months after symptoms resolve; isolation discontinuation requires multiple negative surveillance cultures per CDC/facility protocol, not just absence of symptoms.

## In-depth explanation

CRE is one of CDC's "urgent threat" pathogens because of high mortality and limited treatment options (often only colistin, tigecycline, or newer agents like ceftazidime-avibactam). Long-term colonization is the rule, not the exception — so "patient feels better, take off precautions" is a leading source of horizontal transmission in hospitals.

## Clinical scenario

**Patient admitted with urinary tract infection**; culture positive for **KPC-producing Klebsiella pneumoniae** — a CRE organism. The hospital classifies CRE as a high-priority multidrug-resistant organism (MDRO).

## Key concepts

- **CRE (Carbapenem-resistant Enterobacteriaceae)** — Gram-negative organisms resistant to carbapenems including KPC, NDM, OXA-48, and VIM enzyme producers; CDC urgent threat.
- **KPC (Klebsiella pneumoniae carbapenemase)** — Most common CRE enzyme in the US; hydrolyzes carbapenems; spread by contact with healthcare environments.
- **Contact precaution bundle** — Gown + gloves on entry, dedicated equipment, hand hygiene, chlorhexidine bathing, environmental cleaning emphasis.

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