Individual facilities can’t stop the spread of antibiotic-resistant germs, says CDC. It takes a group effort.
Kudos to hospitals and other healthcare facilities that have implemented antibiotic stewardship programs and sound infection-control practices. But even their best efforts, taken alone, aren’t enough to stop the spread of antibiotic-resistant bacteria and C difficile. Rather, a coordinated approach, involving all healthcare facilities in a region, as well as state and federal authorities, is needed. That is the consensus of the Centers for Disease Control and Prevention, which released the results of a study in a Vital Signs report in early August.
CDC projects that a coordinated approach – that is, healthcare facilities and health departments in an area working together – could prevent up to 70 percent of life-threatening carbapenem-resistant Enterobacteriaceae (CRE) infections over five years. Additional estimates show that national infection control and antibiotic stewardship efforts led by federal agencies, healthcare facilities, and public health departments could prevent 619,000 antibiotic-resistant and C. difficile infections and save 37,000 lives over five years.
How they spread
Antibiotic-resistant germs – those that no longer respond to the drugs designed to kill them – cause more than 2 million illnesses and at least 23,000 deaths each year in the United States. C. difficile caused close to half a million illnesses in 2011, and an estimated 15,000 deaths a year are directly attributable to C. difficile infection, according to the CDC.
C. difficile and drug-resistant bacteria – such as CRE, MRSA (methicillin-resistant Staphylococcus aureus), and resistant Pseudomonas aeruginosa – spread inside of and between healthcare facilities in the absence of appropriate infection control actions and when patients transfer from one facility to another for care, says CDC. Even facilities following recommended infection control and antibiotic use practices are at risk when they receive patients who carry these germs from other healthcare facilities.
A mathematical model developed by CDC demonstrates how coordination could reduce CRE over the course of five years after the drug-resistant bacteria enters 10 facilities in an area sharing patients. For example:
- The common approach (or status quo) results in 2,000 patients getting CRE, impacting 12 percent of patients in the area – not enough to protect patients.
- When a facility acts alone to enhance its infection control practices, the situation improves. This independent effort results in 1,500 patients getting CRE, impacting 8 percent of patients. While this is an improvement, it is not enough to fully protect patients.
- With a coordinated approach, where facilities work together to prevent infections and notify each other of CRE issues before transferring patients, the modeling shows far fewer patients at risk. Four hundred patients are predicted to get CRE, impacting only 2 percent of patients. This is the needed approach to protect patients.
The report describes the importance of public health departments taking the lead to:
- Identify healthcare facilities in the area and know how they are connected.
- Dedicate staff to improve connections and coordination with healthcare facilities in the area.
- Work with CDC to use data for action to prevent infections and improve antibiotic use in healthcare.
- Know the antibiotic-resistance threats in the area and state.
Complementing the public health coordination, the report recommends that hospital owners and healthcare facility administrators consider steps to:
- Implement systems to alert receiving facilities when transferring patients who have drug-resistant germs.
- Review and perfect infection control actions in each facility.
- Make leadership commitments to join area healthcare-associated-infection (HAI)/antibiotic-resistance-prevention activities.
- Connect with public health departments to share data about antibiotic resistance and other HAIs.
- Provide clinical staff access to prompt and accurate laboratory testing for antibiotic-resistant germs.
To view the Vital Signs report, go to http://www.cdc.gov/vitalsigns/
Coordination is key
It’s not enough for individual facilities to institute antibiotic stewardship programs and practice good infection control practices. A coordinated effort is needed. The Centers for Disease Control and Prevention offers this overview of three approaches to the issue:
Common approach (not enough):
- Patients are transferred back and forth from facilities for treatment without all the communication and necessary infection control actions in place.
Independent efforts (still not enough):
- Some facilities work independently to enhance infection control, but are not often alerted to antibiotic-resistant or difficile germs coming from other facilities or outbreaks in the area.
- Lack of shared information from other facilities means that necessary infection control actions are not always taken and germs are spread to other patients.
Coordinated approach (needed):
- Public health departments track and alert healthcare facilities to antibiotic-resistant or difficile germs coming from other facilities and outbreaks in the area.
- Facilities and public health authorities share information and implement shared infection control actions to stop spread of germs from facility to facility.
Source: Centers for Disease Control and Prevention, http://www.cdc.gov/vitalsigns/stop-spread/infographic.html#infographic1
Rogue’s list
The following are some particularly villainous antibiotic-resistant germs, which the Centers for Disease Control and Prevention labels “urgent” or “serious” threats.
- CRE (carbapenem-resistant Enterobacteriaceae): Can cause deadly infections and have become resistant to all or nearly all antibiotics in use today. CRE spread between health care facilities, such as hospitals and nursing homes, when appropriate actions are not taken.
- MRSA (methicillin-resistant Staphylococcus aureus): Commonly cause pneumonia and sepsis, which can be deadly.
- Pseudomonas aeruginosa: Can cause healthcare-associated infections, including bloodstream infections. Strains resistant to almost all antibiotics have been found in hospitalized patients.
- difficile (Clostridium difficile): A germ commonly found in healthcare facilities, can be picked up from contaminated surfaces or spread from a healthcare provider’s hands. Antibiotic use allows C. difficile to take over, putting patients at high risk for deadly diarrhea.
Source: Centers for Disease Control and Prevention, http://www.cdc.gov/vitalsigns/stop-spread/