The media always seem to have a story about the spread of disease and it
might be crying wolf, but these tiny bacteria are going to be around for
a very long time, causing illness and death. The Center for Disease Control
and Prevention (CDC) has been tracking the spread of Carbapenem Resistant
Enterobacteriaceae (CRE) with a great deal of concern, because it is resistant
to nearly all antibiotics. These antibiotic-resistant bacteria can also
cause other bacteria to become resistant, as well.
The CDC classifies events as:
CRE is urgent.
The CDC has documented cases of CRE in every state, with the exception
of Maine, Vermont, Idaho, and Alaska. Cases may be present in those states
as well, they just haven’t been able to make a positive discovery.
There is no medical billing code for CRE under Medicare and Medicaid,
so cases are probably being under reported. The largest populations of
people to contract CRE are those in hospitals, long-term care facilities,
and nursing homes. According to the CDC, more than 2 million people a
year are infected with antibiotic-resistant bacteria.
What Is CRE Bacteria?
Bacteria are found all over the world in all creatures, living and dead.
What makes CRE a very dangerous bacterium is that it produces an enzyme,
Carbapenem, which protects it from antibiotics that could kill it. There
are many bacteria that are resistant to antibiotics, and their populations
are growing with harmful effects to humans. A more familiar antibiotic-resistant
bacterium is E. coli O157:H7 (Escherichia coli). Also, included in these
new strains of bacteria are KPC (Klebsiella pnemoniae carbapenemase) and
NDM (New Delhi Metallo-beta-lactamase). These bacteria are so dangerous
because they not only resist one type of antibiotic, they are able to
mutate and defend themselves against most types of antibiotics. People
who contract CRE have a 50 percent survival rate.
Controlling Outbreaks Of CRE Is Key
The entire medical community has been put on notice by the occurrence of
CRE effecting hospital patients, and residents in long-term care facilities
and nursing homes. There has been enough data compiled to determine how
the CRE super bug is transmitted, and there are precautions the nursing
staff needs to follow to ensure the highest degree of safety for those
under their care.
CRE infects new patients through ventilators, bladder catheters, and IV
catheters. In addition, cases have been found in patients who have had
outpatient procedures using an endoscope. Endoscopes are long, thin tubes
doctors use to look at internal organs, the colon, and bladder. What makes
the medical community and the CDC so worried is that these devices have
been spreading CRE, even after they’ve allegedly been cleaned and
sanitized, the bacteria lives on.
CRE can also be spread through person-to-person contact, through sores,
urine, or stool. Samples taken by the CDC in and around sinks and drains
have also been found to be contaminated with CRE. Hospitals and nursing
homes have been the breeding grounds of illness, and now, they need to
be more precautious to ensure these places are safe for their patients,
the families of the patients, and the staff that work in hazardous conditions
CDC Recommendations To Hospitals And Nursing Homes
1. Hand Hygiene: Good and frequent hand washing, using proper washing techniques
will help reduce the spread of CRE by contact. All patients should wash
hands before and after eating, after using the restroom, before leaving
their rooms and when they return to their rooms.
2. Contact Precautions: All people who are working or visiting patients
with CRE need to have protective gowns and gloves. Hand washing is required
before entering the room and when leaving the room.
3. Healthcare Personnel Education: All healthcare staff should be educated
on the ways CRE can spread and how the spread of it can be controlled.
This applies to the nursing staff and all the support staff in the facility.
4. Use of Devices: (IV catheters, endotracheal tubes, urinary catheters).
Use of any of these devices puts the patient at an increased risk for
contracting CRE. The use of any of these should be limited and discontinued
as soon as possible.
5. Patient and Staff Cohorting: CRE patients should be isolated from the
other patients and should have a dedicated staff to care for them to reduce
the spread of bacteria. Single rooms should be given to patients with
incontinence, medical devices, or wounds.
6. Laboratory Notification: Laboratories should be notified as soon as
CRE patients are suspected or verified as admitted. The labs need to develop
a quick response protocol to contain the spread of CRE.
7. Antimicrobial Stewardship: Classes should be conducted to make sure
staff is using the best available antimicrobial and using them at the
8. CRE Screening: Screening should be used to identify unrecognized CRE.
The screening can come from stool cultures or wounds, if any, and urine.
How Did These Bacteria Become Resistant?
The bacteria are responding to our overuse of antibiotics. They are adapting,
in order to survive. They are also teaching each other how to use enzymes
to protect themselves. People are continually exposed to antibacterial
soaps, hand sanitizers and antibacterial cleaning supplies. Many people
run to the doctor to get antibiotics at the first sign of anything that
might cause them discomfort. Another source of antibiotic overuse comes
from meat animals raised in factory farms. These creatures are given antibiotics
daily to help them grow and to keep them alive. Now the genie is out of
the proverbial bottle.
People have not been proactive enough to control the spread of these super
bugs. Funding issues, staffing shortages, and lack of training have put
everyone at risk for contracting these new strains of bacteria. There
must be practical measures implemented immediately to control the spread
of infectious diseases. Human ignorance has nurtured this problem, and
human negligence has allowed it to spread.
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