What are CRE?
CRE stands for carbapenem-resistant Enterobacteriaceae. Quite a mouthful right? Carbapenem are last resort antibiotics and Enterobacteriaceae are bacteria normally found in the human gut. If we put those together, we’ve got bacteria that are nearly impossible to treat with anything in our current arsenal of antibiotics. They are also lethal. Some strains have been known to kill up to 50% of those people infected. What is most worrisome to many health professionals, including the Director of the U.S. Centers for Disease Control and Prevention, Dr. Tom Friedan, is that this bacteria are becoming increasingly widespread.
The first reported case was in 2001 and since then CRE have been found in 42 states, generally in in-patient healthcare facilities such as hospitals and nursing homes. Eighteen percent of long-term acute care hospitals reported a case of CRE during the first-half of 2012.
People most vulnerable to CRE are those whose immune systems that have already been compromised by illness. If they become infected with CRE, doctors can mistakenly prescribe antibiotics which can kill good bacteria and allow the number of CRE to grow in the body and to spread their antibiotic-resistance to other bacteria. This latter ability is especially frightening. Health officials are afraid that antibiotic-resistant bacteria will become increasingly prevalent and that it will become harder and harder to fight infections because our medical system has become so heavily dependent on antibiotics. In other words, that the dangerous superbugs, that we have feared for so many years, may actually be in the makings.
As Dr. Friedan says, “Everyone involved in medical care from CEOs to patient care staff to health departments needs to act rapidly in a coordinated fashion to stop CRE before our window to control these bacteria closes.”
What can you do to prevent the spread of CRE?
If you are a HEALTHCARE PROVIDER, 6 prevention steps as outlined by the CDC:
1. Know if your patients have CRE, and request immediate alerts from your laboratory every time they identify a patient with CRE.
2. Second, when either receiving or transferring patients, make sure to ask and find out if the patient you're receiving has CRE.
3. Protect your patients from CRE by following contact and other precautions whenever you're getting patients with CRE. Proper hand-washing is key. Medical staff need to wash their hands and change their gloves in between every patient. Also, bathing patients with Chlorhexidine, an antimicrobial soap, can reduce infection from multidrug-resistant organisms.
4. Whenever possible, have specific rooms, equipment, and staff equipped for CRE patients. That reduces the chance CRE will spread from one patient to others.
5. Take out temporary medical devices like catheters as soon as possible.
6. Lastly, and very importantly, prescribe antibiotics carefully. Overuse and misuse increases drug resistant infections and that results in longer inpatient treatment, higher costs, and poorer patient outcomes. Improving antibiotic use is a win-win for hospitals and patients. Hospitals can save and patients benefit from more targeted treatment.
Find the entire CDC toolkit here.
If you or your loved one is a PATIENT in a long-term or acute care facility, the CDC recommends the following:
1. Insist that everyone who touches you during your medical care, doctors, nurses, technicians, visitors, wash their hands before touching you.
2. If you have a catheter, an intravenous line, or a urinary catheter in, ask how long you'll have it and request it be removed as soon as possible.
If you are ENVIRONMENTAL SERVICES (ES) or Housekeeping staff, we encourage you to:
1. Practice good hand hygiene. Use hand sanitizer between every room and wash your hands every third room. This means rubbing all parts of your hands vigorously long enough to sing the “Happy Birthday” song twice (about 20 seconds).
2. Use cleaning chemicals properly. When using any disinfectant make sure it’s diluted correctly and that it sits wet on the surface for the full dwell-time. Check with your infection control practitioner or your ES manager to see which chemicals or disinfectants you should be using.
3. Use personal protective equipment as necessary. Follow standard precautions for personal protective equipment listed on the door of each isolation room. The required equipment will vary depending on the type of isolation such as respiratory, contact or droplet. All equipment should be located immediately outside the room or in the Ante room if so equipped. Dispose of gear and scrubs as you are exiting the room.
4. Follow standard protocol for multi-drug resistant organism (MDRO) room cleaning. One staff member should be dedicated exclusively to clean isolation rooms. This will help prevent MDRO's from spreading throughout the hospital.