Posted on 01/06/2018 8:18:18 PM PST by bitt
A report today from the Centers for Disease Control and Prevention (CDC) on a small outbreak of carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) at a Kentucky hospital in 2016 highlights multiple introduction of the worrisome pathogen in a rural facility and demonstrates the possible role of cleaning equipment.
The investigation by physicians and epidemiologists from the CDC and the Kentucky Department of Health, appearing today in the CDC's Morbidity and Mortality Weekly Report (MMWR), describes an outbreak that started on Aug 11, 2016, when two Klebsiella pneumoniae carbapenemase (KPC)-producing isolates from clinical cultures were reported from patients in a small community hospital in rural Kentucky.
Over the next 4 months, scientists identified an additional 21 CRE isolates from patients at the hospital via screening and clinical cultures. The investigators believe organisms were imported into the facility and then spread among patients.
CRE have been dubbed "nightmare" bacteria because they are resistant to most antibiotics and spread easily from person to person in hospital settings. In addition, carbapenem resistance mechanisms like KPC—the most common carbapenemase enzyme found in CRE samples in the United States—are carried on mobile pieces of DNA called plasmids and can be shared with other types of bacteria, potentially driving wider and more rapid spread of carbapenem resistance. The CDC estimates that more than 9,000 healthcare-associated CRE infections occur each year in the United States.
Invasive CRE infections can be severe and deadly in critically ill patients, with mortality rates as high as 50%. More often, however, patients identified as CRE carriers are asymptomatic. But these colonized patients can still transmit the organism to other patients.
Importation and transmission Of the 23 CP-CRE isolates identified, 17 (74%) were detected through screening cultures and the rest from clinical cultures. Further analysis of 14 available isolates revealed that 12 were K pneumoniae and two were Escherichia coli; in addition, 13 of the isolates produced the KPC enzyme and one produced the New Delhi metallo-beta-lactamase enzyme.
Pulsed-field gel electrophoresis identified three indistinguishable pairs of isolates that were isolated from patients who had exposure, based on medical chart review and patient interviews, to the emergency department or to the same medical-surgical ward. The investigators believe that's an indication that CP-CRE transmission occurred in these units.
Interviews with 13 of the patients also revealed that five had received healthcare outside the local area. The investigators suggest that 3 of these patients may have introduced CP-CRE into the facility; 2 had CRE identified at screening admission. But environmental cultures also identified CP-CRE on an emergency department environmental services cart and in a floor sink drain in a closet in the involved medical surgical ward.
The authors of the report say their investigation highlights the potential role of cleaning equipment, which frequently moves between patient rooms, in CP-CRE spread. In addition, they note that although there is a low prevalence of CP-CRE in rural areas, rural hospitals should be aware that patients who've also accessed healthcare in areas with higher CP-CRE prevalence—primarily urban areas—can introduce these organisms into their facilities.
The authors suggest that the facility initiate CRE surveillance in patients with known exposure to healthcare in areas with higher CP-CRE prevalence, reinforce daily and terminal cleaning practices, and work with other facilities in their patient-sharing network to implement a CP-CRE control strategy.
See also:
Jan 5 MMWR Notes from the Field
CRE - it’s a nasty bugger..
#1 way to stop the spread of disease in hospitals? Hand washing. I have never seen a RN and rarely a MD wash their hands before an examination. I also wonder how often that stethoscope is scrubbed, along with the BP cuffs.
Thanks for the ping/post. Health/life BUMP!
I have been thinking about this a lot. So many scientific & medical journals have come out & said simple hand washing would save so many lives & prevent so many infections. HAND WASHING!!!!
Like you said I cannot remember a time that a doctor or nurse has washed up upon entering the room & before touching me. It really is appalling. Also we are often immunity deficient when we go to the doctor making us even more vulnerable to germs & bacteria. Why the hell are we put at risk like this?
Great post!!! Maybe a medical professional can answer your question.
In my little, backward rural town in SW Oregon my GP always washes his hands when he enters the room.
Think about getting a flu shot. The nurse comes in with a tray that has a sterile cloth on it, with the syringe with sterile cap, alcohol wipes and a bandaid. Yet does the nurse wash up before putting on gloves? Did they wash before preparing the tray? Simple law of sterility teaches that once something non-sterile touches a sterile surface the entire object is contaminated.
I also do not like it that I have had doctors not wear gloves when doing an external exam in certain areas. One little bit of bacteria under the fingernail and it could spread to every other patient he sees that day.
You've never heard of CRE before ? You're not alone !
CRE = carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE)
CRE have been dubbed "nightmare" bacteria because they are resistant to most antibiotics and spread easily from person to person in hospital settings.
Transmission appears to be lower in more rural healthcare facilities, but that could reflect either failure to report the incidence, or, failure to test for the disease.
Invasive CRE infections can be severe and deadly in critically ill patients, with mortality rates as high as 50%.
More often, however, patients identified as CRE carriers are asymptomatic.
But these colonized patients can still transmit the organism to other patients.
(See the original news source listed for more information about CRE and the ease of transmission, especially in a hospital setting)
Hat Tip to bitt !
They use a lot of that stuff called Purell to kill the germs but I remember reading that stuff only has a limited positive effect as compared to washing hands.
On the other hand (pun intended) medical people couldn’t possibly wash their hands 40 times a day without their skin cracking which would open them up to all kinds of nasties. I guess using rubber gloves is an option or maybe alternating between the Purell and washing hands being mindful of the patient. Some need to be handled differently for obvious reasons.
CRE includes the genre CPE, but most CRE are not CPE.
CPE is such a big problem because the means of resistance are transmissible to other bacteria of the same family.
I work at a hospital (IT Staff), and I can tell you that hand washing is an almost compulsive behavior among the staff that are in direct contact with patients. Hand sanitizer has replaced soap and water in most applications. PPE and soap and water are mandatory in cases where the patient is in isolation for whatever reason.
I can tell you that after being around some patients (like the guy with MRSA AND drug resistant TB) you feel like dunking your entire body in sanitizer, taking a steaming shower, then toweling off with the purple top wipes they use to sanitize equipment (not for human use). Sometimes I really dislike my job.
Scroll down for the KPC-producing chart. Every state but Idaho. Yikes.
Hand sanitizer is more effective than hand washing.
They do wash hands and wear gloves routinely in most states. CA and NY may be exceptions.
They wash hands and wear gloves routinely. And here’s a really big one, most infectious agents are brought in by patients; now, are you ready for this— Because hospitals are collecting points for sick people.
With diseased patients collecting in hospitals, it is impossible to sterilize them and the environment. Why don’t you propose putting the entire operation in an autoclave, along with all the patients before they are allowed in.
Common sense is not common to most of the public. Most people simply don’t understand that hospitals are collection points for sick people.
steamed people. Soilent red?
“But environmental cultures also identified CP-CRE on an emergency department environmental services cart and in a floor sink drain in a closet in the involved medical surgical ward.”
Hospitals carry so many germs. It’s truly worrisome that the one place we go for care is the same place that can cause terrible illnesses.
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