(See endnotes 24, 25, 29)
The CDC estimates on a yearly basis 2 million illnesses and 23,000 deaths are caused by antibiotic-resistant bacteria in the United States. There has been a huge overuse of antibiotics and misuse of antibiotics both in the healthcare fields and in food production. Outbreaks of disease- causing organisms resistant to antibiotics include carbapenem-resistant Enterobacteriaceae and particularly Klebsiella pneumonia carbapenem-resistant Enterobacteriaceae (See endnote 27), and C. difficile which is resistant to many drugs. Also vancomycin-resistant Enterococci (VRI), methicillin-resistant S. aureus (MRSA), and S. aureus with intermediate levels of resistance to glycopeptide antibiotics are serious concerns in the spread of hospital-acquired infections. This is especially important in intensive care units and other areas where patients may be immunocompromised.
People are the primary reservoir of the organisms even though they may be found on various types of equipment that come in contact with the patient, floors, frequent touch surfaces, and in hydrotherapy tanks which are of special concern for burn victims. Contamination of the surfaces increases substantially when patients have diarrhea and when there is improper removal and cleaning up of the fecal contamination. Misuse of gloves by healthcare workers can spread the microorganisms to the various surfaces. Also these organisms can be easily spread from patient to patient, from patient to healthcare worker to their families and back to patients and to others who come into direct or indirect contact with the individuals or especially their hands. The organisms can persist on surfaces for periods lasting from a week up to several months. They can persist on the hands or gloves of healthcare workers for up to 60 minutes.
Best Practices for Preventing the Spread of Antibiotic-Resistant Bacteria
- • Decrease the amount of antibiotics being used in health care and in food production.
- • Use a national One Health surveillance system to reduce the numbers of resistant organisms. This system integrates public health and veterinary disease, food, and environmental control. A regional laboratory network is needed to support the system by using innovative diagnostic tests and rapidly disseminating the results. Best Practices in infection control must be instituted when resistant organisms are identified.
- • When transferring patients from one healthcare facility to another, clearly communicate to the new facility the nature, care, and treatment of individuals with infections so that proper infection control procedures may be used.
- • Encourage state authorities to make the records of antibiotic-resistant bacteria patients a reportable event so that there can be accurate information concerning possible spread of disease.
- • Use specialized teams of trained housekeeping personnel wearing gowns, gloves and if needed masks, and under strict supervision to thoroughly clean the entire area where the patient is treated and is housed, and especially frequent contact surfaces. Use increased frequency over and above normal cleaning of patient units for areas contaminated with infections. Dispose of all contaminated clothing prior to leaving the room.
- • Healthcare workers and housekeeping personnel should wash hands thoroughly before entering the area where there are infected patients and after removing gloves and gowns prior to leaving the area.
- • All housekeeping equipment should be considered to be contaminated and needs to be decontaminated before use in other areas.
- • Make sure that all healthcare employees are aware of the potential for infection within the room where the patient is residing.
- • Make sure that bathrooms are especially cleaned and disinfected.
- • Teach the patients the necessity for proper hand washing after going to the bathroom, before coming in contact with other people, and also before preparing or consuming food.
- • Have patients use chlorhexidine gluconate-impregnated bath cloths to reduce microorganisms when taking baths. (See endnote 27.)