CDC has taken a stand because the U.S. is threatened by a Hospital-Acquired Infection (HAI) known as Carbapenem-resistant Enterobacteriaceae. CRE germs are resistant and untreatable by any antibiotic that is known today.
The heightened alert has created a huge scare because the numbers have increased so dramatically between 2001 and today. In 2001 the infection rate for enterobacteriaceae was 1.2%. It has now increased to an alarming rate of 4.6% of hospitals in 2012 that reported at least one incidence; 3.9% of short-stay hospitals reported at least one and the largest increase was found within long-term acute care hospitals with an alarming 17.8% having at least one case of reported CRE infection.
Another concern about CRE is that the germs spreads so quickly. CRE germ initially kills off good germs, then begins to reproduce new CRE germs. CRE also shares genetic defenses, which makes other bacteria resistant to antibiotics.
Antibiotics kill some cells. Therefore, when the remaining cells reproduce, they tend to be the cells that were resistant to that antibiotic. The result of this is that a higher and higher percentage of the remaining CRE cells are resistant to the antibiotic. The body is truly amazing. It goes to show the validity that Gods greatness in providing the very foods on earth that are the only thing that helps cells to reproduce new and healthy cells to fight off bad infectious cells versus that of the Medical society that provides man made chemicals of killing cells. Medical society does not out smart GOD.
Patients most at risk
Patients who are most at risk are people who are in healthcare settings like hospitals, long-term care, and skilled nursing facilities. Additionally, patients who uses ventilators or catheters. Also, if a patient has taken antibiotics for a long period of time, then you may be at risk for CRE infections.
Immediate Action Needed
Never the less, rapid action must now be taken to out smart these germs. On a Federal level, CRE infections must be reported and tracked through the National Healthcare Safety Network (NHSN) and Emerging Infections Program (EIP). The government must also provide the research, skills, expertise and testing to states and facilities. Additionally, they must provide prevention control programs that will take measures to prevent the germs from transferring from one person to another through common practices and treatment of patients.
State and Local authorities must make it a high priority to know the CRE trends and coordinate regional CRE tracking and control efforts. They should take a proactive stance and initiate procedures in hospitals and other care facilities that have not been infected yet by the germ. Strict laws should be in place to alert hospitals when transferring patients with any infection. States now need to consider including CRE infections on states’ notifiable disease lists, which is not presently a requirement.
Rapid action must be taken by hospitals and long-term care facilities to prevent the increase and spread of this very infectious germ. Patients whose care requires devices like ventilators (breathing), urinary (bladder) catheters, or intravenous (vein) catheters, and patients who are taking long courses of certain antibiotics are among those most at risk for CRE infections, and special precautions should be standard among all such facilities.
Core Measures
There are 8 core measures facilities should follow.
1. Hand Hygiene – Hand hygiene is a primary part of preventing multi-drug-resistant organism (MDRO) transmission. Facilities should ensure that healthcare personnel are familiar with proper hand hygiene technique as well as its rationale. Proper use of Contact Precautions includes:
- Performing hand hygiene before donning a gown and gloves
- Donning gown and gloves before entering the affected patient’s room
- Removing the gown and gloves and performing hand hygiene prior to exiting the affected patient’s room
2. Contact Precautions – People who are infected with CRE should be placed on contact precautions. Systems, including a defined CRE protocol should be in place for if a patient is known previously to have had CRE.
3. Healthcare Personnel Education – HCP (in all settings) who care for patients with MDROs, including CRE, should be educated about preventing transmission of these organisms.
4. Use of Devices – Use of devices (e.g., central veinous catheters, endotracheal tubes, urinary catheters) puts patients at risk for device–associated infections and minimizing device use is an important part of the effort to decrease the incidence of these infections. More information can be found in the Guidelines for the Prevention of Intravascular Catheter-Related Infections and Guideline for Prevention of Catheter-associated Urinary Tract Infections, 2009.
5. Patient and Staff Cohorting – When available, patients colonized or infected with CRE should be housed in single patient rooms
6. Laboratory Notification – Laboratories should have protocols in place that facilitate the rapid notification of appropriate clinical and infection prevention staff
7. Antimicrobial Stewardship – Antimicrobial stewardship is another primary part of MDRO control. This intervention is applicable to both acute and long-term care settings.
8. CRE Screening is used to identify unrecognized CRE colonization among epidemiologically-linked contacts of known CRE colonies or infected patients, as clinical cultures will usually identify only a fraction of all patients with CRE. Generally, this screening has involved stool, rectal, or peri-rectal cultures and sometimes cultures of wounds or urine (if a urinary catheter is present).
Abbreviated measures have been listed here – you can find a full listing of the Preventive Measures on the CDC website. http://www.cdc.gov/hai/organisms/cre/cre-toolkit/f-level-prevention.html#facility-strategies