CRE Bacteria Infection (Carbapenem-Resistant Enter (cont.)

Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

Jerry R. Balentine, DO, FACEP

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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2. Contact Precautions

Acute care

• Place CRE colonized or infected patients on Contact Precautions (CP)
  • Preemptive CP might be used for patients transferred from high-risk settings
• Educate healthcare personnel about CP
• Monitor CP adherence and provide feedback
• No recommendation can be made for discontinuation of CP
• Develop lab protocols for notifying clinicians and IP (Inpatients or Hospitalized patients) about potential CRE

Long-term care

• Place CRE colonized or infected residents that are high-risk for transmission on CP (as described in text); for patients at lower risk for transmission use Standard Precautions for most situations

3. Patient and staff cohorting (grouping)

• When available group (cohort) CRE colonized or infected patients and the staff that care for them even if patients are housed in single rooms
• If the number of single patient rooms is limited, reserve these rooms for patients with highest risk for transmission (for example, incontinence)

4. Minimize use of invasive devices

5. Promote antimicrobial stewardship

6. Screening (screening for CRE bacterial strains in patients and in high acuity areas, for example, Intensive care units and Isolation rooms used for patients with infections)

The CDC further recommends that patients identified with CRE infections should be bathed with 2% chlorhexidine and that areas that house or treat CRE infected patients undergo strict decontamination treatments. Instruments that may be in contact or used to diagnose or treat CRE infected patients should also undergo rigorous decontamination.

We humans have many dangerous microbial enemies; many researchers and health care professionals think CRE bacteria could be the first wave of many others. The CDC is giving guidance to healthcare workers about how we can possibly reduce or prevent a large scale outbreak of CRE bacteria; I agree with the CDC that suggests we humans act world-wide now before these bacteria spread and transfer their resistance to future bacterial populations.

REFERENCE: CDC.gov. 2012 CRE Toolkit - Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE) Part 1: Facility-level CRE Prevention.