The superbug CRE, or carbapenem-resistant Enterobacteriaceae, has roared back into national headlines. This multi-drug resistant hospital-acquired infection (HAI) is much feared for good reason. The death rate is as high as 50%.
The current news reports are focused on hard to clean duodenoscopes. These scopes are used in more than half a million medical procedures each year, and are responsible for at least eight CRE outbreaks nationwide.
Health care professionals are taking new measures to fight the spread of CRE.
Testing Scopes for CRE
Hospital infection control directors at many hospitals are heeding the alarm and stepping up surveillance. Swedish Medical Center now performs daily cultures of these scopes to check for hard to kill Gram-negative germs like CRE. After being cleaned and tested, the instruments are held until they are proven free of dangerous bacteria. This test-and-hold policy is a pending protocol being developed by the Centers for Disease Control and Prevention (CDC.) No doubt it will go far in fighting the spread of CRE.
Currently, only 20 states require health care facilities to report CRE. While this is a dramatic increase from just two years ago when only 6 states required reporting, many officials now feel that there should be national surveillance of CRE with all states required to report.
“CRE infections already are endemic in several major U.S. population centers, including New York, Los Angeles and Chicago, which account for hundreds of confirmed cases. Smaller pockets of cases have been reported across much of the country, including Oregon, Wisconsin, Minnesota, Pennsylvania, Maryland, Virginia and South Carolina.” – USA TODAY
Other experts advocate taking surveillance beyond mandatory reporting. To assist hospitals with infection control isolation, Illinois runs a state registry of CRE-infected patients. Health officials can survey hospital lab data for CRE, and hospitals can routinely monitor high-risk areas.
When Los Angeles last conducted a county CRE survey in 2011, they discovered a lot more cases than they expected. The study revealed 675 cases for a one-year period ending in May 2011.
“Two-thirds of the 102 acute-care hospitals analyzed had at least one case. The infection rate was significantly higher inside the eight long-term-care facilities reviewed.” – Los Angeles Times
Surveillance and reporting will help experts understand how CRE is transmitted in the health care system so they can better fight its spread.
Some health care organizations are employing the use of new technology to kill CRE and other deadly germs in hospital rooms – robots that emit ultraviolet light.
Merlin, a 5-foot tall robot made by San Antonio-based company Xenex, cost Providence Tarzana Medical Center just over $100,000. In just five minutes, Merlin sends out 450 pulses of UV light, obliterating drug-resistant bacteria like CRE from door handles to bed rails.
Nearly 300 of these robots are working hard to fight the spread of CRE in health care facilities here in the US.
Hand Hygiene and Glove Use
While germ-zapping robots may be coolest new tool to fight CRE, the front lines are still proper hand hygiene and glove use.
The CDC recommends 8 core measures to prevent the spread of CRE.
Number one on the list is strict adherence to hand hygiene.
- “Hand hygiene is a primary part of preventing multidrug-resistant organism (MDRO) transmission.”
- “It is not enough to have policies that require hand hygiene; hand hygiene adherence should be monitored and adherence rates should be fed directly back to front line staff.”
- “Further information on hand hygiene is available at CDCs Hand Hygiene in Healthcare Settings”
Number two is the Proper Use of Contact Precautions, including:
- “Performing hand hygiene before donning a gown and gloves”
- “Donning gown and gloves before entering the affected patient’s room”
- “Removing the gown and gloves and performing hand hygiene prior to exiting the affected patient’s room”
Patients requiring ventilators, on urinary and intravenous catheters, and patients on long courses of certain antibiotics are at higher risk for CRE infections. With new surveillance, new technology, and diligent adherence to proper hand hygiene and glove use, we can minimize the risk to millions.