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The question
In a 20-bedded intensive care unit with no single rooms, six patients over three weeks are found to carry a carbapenem-resistant Klebsiella with the same resistance gene, although only two have clinical infection. Hand hygiene compliance is audited at 45%, three ventilators are shared between bays, and one nurse covers four beds at night. Two of the six are ventilated, environmental swabs from a shared procedure trolley have grown the same organism, and the unit has one sink for twelve beds. Which package of measures is most likely to end the outbreak?
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