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| Carbapenem-resistant Enterobacteriaceae |
Carbapenem-resistant Enterobacteriaceae (CRE) has been deemed an urgent public health hazard by the CDC. (Sources: Antibiotic Resistance Threats in the United States, 2013: http://www.cdc.gov/drugresistance/threat-report2013/pdf/ar-threats-2013-508.pdf and the 2012 CRE Toolkit – Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE): http://www.cdc.gov/hai/organisms/cre/cre-toolkit/background.html ) With that in mind, the HAI Advisory Group recently formed two Task Forces to concentrate on the prevention and detection of CRE. Some pertinent information regarding CRE infection is provided below followed by details for ongoing and planned activities to assess and reduce current prevalence in affected healthcare settings.
Background:
CRE are
a group of bacteria found in the gut.
They can cause a variety of diseases including pneumonia, UTIs, and
serious bloodstream or wound infections.
CRE are resistant to commonly used antibiotics and occasionally to all
available antibiotics, which makes them a serious threat to public health.
Who is at risk?
Patients
who require devices like ventilators, urinary catheters, or intravenous
catheters, and patients who are taking long courses of certain antibiotics are
most at risk. CRE have been found among patients in both acute and long term
care settings.
How is it spread?
CRE
bacteria are spread by person-to-person transmission, primarily in healthcare
settings, through contact with those infected or colonized. Due to the movement
of patients throughout the healthcare system, if CRE are a problem in one
facility, then typically they are a problem in other facilities in the region
as well.
How is it controlled?
Treatment
is difficult, and not possible in some cases.
As a result, prevention and control measures are critical. Standard practices such as hand washing,
contact precautions, and communication of CRE status with
transferring/receiving facilities can help prevent the spread of disease.
Healthcare
Task Force
The
Healthcare Task Force is composed of members from acute care, long term acute care,
and long term care facilities and is focusing on the prevalence of CRE within
the state and what actions can be taken to help educate healthcare providers
concerning the importance of CRE prevention.
A webinar by Dr. Katie Passaretti was presented in August and a
recording of the webinar may be found on the NCQC and SPICE websites.
Three
CRE prevalence surveys are being developed by the Task Force: one each for
Infection Preventionists, acute care laboratories, and long term care
facilities. These surveys will be distributed during the first quarter of 2014 and
will solicit CRE information for 2013. Awareness and evaluation of CRE is
increasing across the United States, and with that other states including
Virginia, Oregon, and Michigan have also been implementing CRE surveys. Some states have shared their questionnaires
and/or results with North Carolina, and as such the 2014 NC State CRE surveys
are being adapted in the context of successful assessments already completed by
other states. In general, responses seem
to indicate a need for ongoing education on appropriate CRE practices and up-to-date
prevalence data from both acute and long term care settings, with a focus on CRE-related
facility transfer policies.
Laboratory
Task Force
The CRE
Laboratory Task Force is composed of members are laboratorians from acute care
facilities and the NC State Lab of Public Health. It is tasked with determining the best
method(s) for CRE detection and notification. This group is formulating guidelines
and algorithms for North Carolina Laboratories on testing for CRE. The
guidelines will be general enough that both large and small healthcare
laboratories can implement them. The
guidelines will include a definition of CRE as well as procedures for testing, verifying,
and reporting the results. An algorithm
which outlines the identification process is also being developed. The sub-group is reviewing each automated
system used for CRE testing and writing the guidelines to accommodate the most commonly
used systems.
Article submitted by:
Connie Jones, RN, CIC
HAI Prevention Program
Coordinator
And
Megan Sanza, MPH
HAI Prevention Program
Epidemiologist
