529. Halting Multi-Modal Transmission of a Novel Carbapenemase-Producing Enterobacteriaceae Outbreak

BACKGROUND: In January 2018, the first case of anOXA-48 carbapenem-resistant Klebsiella pneumoniae (OXA-48 CRKP) was identified in a North Carolina hospital in a patient arriving from Eastern Europe. Over the next year across multiple inpatient adult units, 14 patients had clinical isolates and 2 patients had positive rectal surveillance screens for OXA-48 CRKP. METHODS: Investigation activities to characterize the OXA-48 CRKP epidemiology included: >1000 rectal colonization screens of epidemiologically linked patients, chart reviews of infected and colonized patients, hand hygiene and environmental cleaning observations on affected units, environmental sampling to include endoscopes, sinks and toilets, and molecular analyses (pulsed-field gel electrophoresis and whole-genome sequencing). RESULTS: Molecular analyses confirmed a clonal outbreak. All environmental cultures including endoscope cultures performed were negative for OXA-48 CRKP. All cases were explained by at least one of three mechanisms: (1) time/space overlap on same unit (presumed lack of hand hygiene or contamination of shared patient equipment), (2) patient housed in room where previously infected patient was housed (presumed inadequate terminal disinfection/contaminated environment), or (3) a single upper gastrointestinal endoscope. Interventions included surveillance to identify and isolate colonized patients, discharge room cleaning of OXA-48 CRKP patients enhanced by ultraviolet light disinfection, curtain laundering, and discarding unused patient supplies, and monitoring and feedback for compliance with hand hygiene, cleaning, and use of personal protective equipment. A single endoscope used between multiple OXA-48 CRKP patients with no other known transmission link was quarantined upon identification, sterilized with ethylene oxide, and ultimately placed out of service. CONCLUSION: A clonal outbreak of a novel carbapenemase-producing Enterobacteriaceae likely spread via multiple modes of transmission. The investigation was complicated by infrequent identification of colonization among patients epidemiologically linked to known cases. Multiple interventions based on epidemiological links were necessary to halt hospital-wide transmission. DISCLOSURES: All authors: No reported disclosures.