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Friday, February 8, 2013

Fancy that – Implementing Tougher Standards Halts Outbreak

The January 30th edition of The Wall Street Journal ran an article titled “When Hospitals Become Killers” by Betsy McCaughey that detailed an outbreak of Carbapenem-Resistant Klebsiella (CRK for short) that infected 18 and killed 6. 

Klebsiella is a gram-negative rod shaped bacteria that is known to cause pneumonia, urinary tract infections, septicemia, and soft tissue infections.  As with other bacteria, Klebsiella has now become resistant to several antibiotics.  In particular, Klebsiella has become resistant to the Carbapenem family of antibiotics that are used to treat life-threatening infections caused by extremely drug-resistant gram negative pathogens; these drugs represent the last line of defense in the antimicrobial drug arsenal against serious or invasive infection.

Early detection through the use of targeted surveillance and introduction of strict infection control measures including the reinforcement of hand hygiene, contact precautions and environmental cleaning and disinfection protocols can help control the spread of CRK.  This is of particular importance with nosocomial pathogens such as CRK as these organisms can persist both in the hospital environment and can also colonize healthy individuals who can then contaminate the environment.

During the outbreak at the National Institutes of Health Medical Center (Bethesda, MD), the outbreak was finally contained by implementing tougher standards such as screening all patients for CRK, strict cohorting of colonized patients to minimize sharing of hospital equipment and of care providers between outbreak patients and other patients in the hospital and more rigorous cleaning.

Fancy that!  More rigorous cleaning!  In fact they cleaned the surfaces twice per day.  Further support for last week’s The Ugly Truth blog where researchers found that bacteria grew back at alarming rates after cleaning the surfaces and found that the optimal cleaning frequency would be every 3 hrs.

While to some, these articles may be surprising, I think we have to come to the realization that this is the new norm.   Our focus for too long has been on the cure.  We have vaccines and we have antibiotics.  But as we are seeing time and again, we are coming up against stronger enemies.  The antibiotics we rely so strongly on are not capable of defeating the newly developing antibiotic-resistant bacteria.  Without a strong focus on PREVENTION we will run the risk of reading headlines that highlight yet another outbreak and with more deaths. 

Is it enough to implement tougher standards after the fact?  Perhaps we need to implement tougher standards ALL the time!  Washing our hands and cleaning the environment works.  Why don’t we just do it?

Bugging Off!

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