Developing Regionally Coordinated Infection Control Strategies for Carbapenem-Resistant and Carbapenemase-Producing Enterobacterales in Acute and Long-Term Care Hospitals: A Delphi Study.

BACKGROUND

Carbapenem-resistant Enterobacterales (CRE), particularly carbapenemase-producing Enterobacterales (CPE), remain a major global public health concern. In Korea, reports from acute care hospitals (ACHs) have increased in absolute numbers, while those from long-term care hospitals (LTCHs) have risen both in numbers and in proportion. This Delphi study aimed to develop expert consensus to inform national CPE infection control policy by identifying key challenges, essential program components in ACHs and LTCHs, and strategies for regional coordination between healthcare facilities.

METHODS

A three-round Delphi study was conducted between October 2024 and February 2025 with 19 experts, including infectious disease physicians and infection control nurse leaders. The first round consisted of open-ended and multiple-choice questions to assess expert responses on the current practices and areas for improvement. Based on these responses, 85 items were rated on a 10-point Likert scale in the second and third rounds. Consensus was determined using content validity ratio, degree of convergence, and degree of consensus. Final strategies were then proposed by prioritizing items with the highest agreement and adapting them to the Korean healthcare context.

RESULTS

Of 85 items evaluated, 56 achieved consensus. In ACHs, the highest priorities focused on strengthening surveillance activities for high-risk patients with CRE/CPE, antimicrobial stewardship, and healthcare-associated infection surveillance, supported by sufficient financial and workforce resources. In LTCHs, the top priorities included admission screening and testing for CRE/CPE supported by national reimbursement and effective communication within and between healthcare facilities to ensure timely information transfer. Experts prioritized implementing standardized transfer records to indicate whether patients are CRE/CPE carriers or belong to high-risk groups, and expanding national reimbursement for screening, testing, and related infection control activities as key measures to enhance information sharing and regional collaboration.

CONCLUSION

The Delphi consensus identified key priorities to strengthen CRE/CPE surveillance and antimicrobial stewardship in ACHs, expand reimbursed screening testing in LTCHs, and establish standardized interfacility transfer communication. These findings support regionally coordinated policies to enhance CRE/CPE infection control in Korea provide evidence for national policy development.