One major media outlet recently reported that CRE cases have now been identified in 42 states. The number of hospitals and nursing homes which have experienced CRE outbreaks grows by the day.
CRE stands for Carbapenem resistant enterobacteriaceae which “are gram-negative bacteria that are nearly resistant to the carbapenem class of antibiotics, considered the ‘drug of last resort’ for such infections. Experts fear CRE as the new ‘superbug.’ The bacteria can kill up to half of patients who get bloodstream infections. These superbugs are referred to as “nightmare bacteria” even by the head of the CDC, Tom Frieden.
How did this superbug infection get to be so out of control?
CRE is known to proliferate in nursing homes, long term car facilities and hospital ICUs and CCUs. These specific healthcare environments tell the story. The staff in these units are usually working under an inordinate amount of stress. The facilities are in constant use 24 hours a day, 7 days a week, and 52 weeks a year. Proper hygiene, sanitation and sterilization are often the first to be sacrificed during emergencies and super-busy workloads. They are also underperformed by staff that is routinely overworked and underpaid.
A hospital-acquired infection (HAI) or nosocomial infection has always represented the greatest risk to any patient entering a hospital or nursing home. Because most patients are already compromised due to their primary illness, injury or disease process, exposure to a superbug can be extremely dangerous and often fatal.
In the case of CRE, the mortality rate has been determined to be between 40 and 50%. In some settings the mortality can be even higher given the medical profiles of those weak and vulnerable patients. The patient’s age, of course, is also a major risk factor which is why nursing homes are so vulnerable.
The Most Dangerous Source of CRE Contamination and Dissemination
Perhaps the most dangerous sources of CRE contamination are the many medical devices and equipment which have reusable tubes and probes and other parts which come into direct contact with the patient. When proper sterilization does not take place with medical device parts, the consequences can be quite serious and manifest rapidly. For example, endoscopes were recently implicated at the Ronald Reagan UCLA Medical Center.
Any kind of reusable plastic tubing is especially susceptible to CRE contamination, as well as other types of pathogenic microbial agents. A dark narrow tube is extremely difficult to properly sanitize in the first place. The prescribed fluids which are run through the equipment tubes have various ingredients, each of which have varying degrees of viscosity and residuals. The more buildup of those residuals in the device and equipment tubing, the greater the likelihood that biofilms will form. Once biofilms start to build up to any degree, the tubes have been compromised virtually beyond repair. The plastic material of most tubing also provides a very conducive environment for pathogenic microorganisms to thrive in.
High Cost Of Health Care Has Its Price
Cost reduction, cost containment and cost-saving measures are intensifying all over the American healthcare industry. In an effort to decrease the exorbitant medical costs of a hospital stay, corners have been cut. In many cases it is the quality control departments across “Hospital USA” which have seen the biggest budget cuts, if they have not been abolished altogether.
Similarly, the appointed infection control nurses usually wear many hats. In larger institutions they often find themselves putting out fires instead of taking the many preventative measures which ought to be in place each and every day. For this reason CRE infections are likely to increase and become more lethal.
In the final analysis CRE infections will be viewed as a completely preventable and human-caused occurrence. If only healthcare facilities followed the common sense hygiene and sanitation procedures that they are told and trained to follow would CRE-types infections be a healthcare phenomenon of the past.
It is good practice for anyone entering a hospital to have an advocate – family member, friend or minister – who is available to review all upcoming procedures with the doctor. Likewise, the assigned nurse can be enlisted to make sure that high cleanliness standards are adhered to throughout the hospital stay.
Iatrogenic illness and injury is another medical phenomenon which has seen a marked increase over the past decade. Therefore, it is wise to be accompanied when ever possible by another trusted individual who can evaluate the hygiene protocols of the attending physicians. Stethoscopes have been identified as another major source of superbug infections around GP surgeries and hospital wards.