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SNF strategy for combatting drug-resistant CRE

March 8, 2013
by Pamela Tabar, Senior Editor
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The wily and drug-resistant Carbapenem-Resistant Enterobacteriaceae  (CRE) have been found in 18 percent of nursing homes and 4 percent of hospitals nationwide, the Centers for Disease Control & Prevention (CDC) announced earlier this week. Healthcare facilities find the rates disturbing, especially considering how difficult the bacteria are to treat—the CDC estimates that up to 50 percent of the cases can be fatal.

But CRE outbreaks are of special concern for skilled nursing facilities (SNFs), since the bacteria can spread easily as patients are moved among hospitals, SNFs and off-site rehabilitation centers, notes the American Health Care Association/National Center for Assisted Living, which recently issued updated practice guidelines for bacterial infection control.

SNFs routinely care for those who are frail and/or aged, who by nature's default have less robust immune systems. In addition, many SNF residents experience incontinence or use catheters and other devices, any of which can increase the risk of CRE transmission. The most common sources for CRE bacteria are urine and blood, the CDC says.

And, unlike the patients in acute-care settings, SNF residents regularly socialize and eat together, complicating the chain of contact. The CDC urges SNFs to isolate residents as soon as an infection is detected, but residents may come into contact with a number of other residents and staff before the bacteria’s incubation period allows the illness to show itself.

The CDC offers a CRE toolkit to help SNFs and other long-term care facilities guard their gates and train caregivers in the protocols for controlling the dangerous bacteria. The CDC’s core recommendations include the following:

  • All caregivers and staff must employ proper hand hygiene (even when gloves are used)
  • Contact precautions should be put in place for residents who are or have been infected within the past three months.
  • Active surveillance testing and preemptive contact precautions should be implemented within the SNF when a local hospital or other care facility experiences a CRE infection.
  • Caregivers should be trained before an outbreak occurs, with intensified training for SNFs that receive residents from a hospital that has experienced a number of CRE infections.

For additional clinical information on CRE's symptoms and characteristics, read the CDC’s March 5, 2013 report on CRE.

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