Multidrug-resistant organisms (MDROs) MDROs are microorganisms, mainly bacteria, that are resistant to one or more classes of antimicrobial agents. These pathogens are usually resistant to all but a few commercially available antimicrobial agents, so MDROs are considered to be epidemiologically important and deserve special attention in mortuary facilities. MDROs are transmitted by the same routes as other infectious agents. Preventing the emergence and transmission of these pathogens requires a comprehensive approach that includes administrative involvement, education and training of personnel, comprehensive surveillance for targeted MDROs, application of infection control precautions, and environmental measures such as cleaning and disinfection of the environment and equipment. MDROs include: ● Clostridium Difficile (C. diff). ● Carbapenem-resistant Enterobacteriaceae (CRE). Agents of bioterrorism The CDC has designated agents that cause anthrax, smallpox, plague, tularemia, viral hemorrhagic fevers, and botulism as Category A, high priority, because these agents can be easily dispersed environmentally, through food, water, air, and/or transmitted from person to person; can cause high mortality and have the potential for major public health impact; might cause public panic and social disruption. These agents identified by the CDC include the following: ● Arenaviruses. ● Botulism (Clostridium botulinum toxin). ● Ebola virus hemorrhagic fever. ● E. coli O157:H7 (Escherichia coli). ● Emerging infectious diseases such as Nipah virus and hantavirus. ● Epsilon toxin of Clostridium perfringens. ● Escherichia coli O157:H7 (E. coli). Prions The CDC defines transmissible spongiform encephalopathies (TSEs) as a family of rare, progressive neurodegenerative disorders that affect both humans and animals. They are distinguished by long incubation periods, characteristic spongiform changes associated with neuronal loss, and a failure to induce inflammatory response. The causative agents of TSEs are believed to be prions. The term “prions” refers to abnormal pathogenic agents that are transmissible and are able to induce abnormal folding of specific normal cellular proteins called prion proteins that are found most abundantly in the brain. The functions of these normal prion Identified prion diseases in humans Creutzfeldt-Jakob disease (CJD) is a rapidly progressive, degenerative, neurologic disorder of humans caused by an infectious, highly transmittable prion. The incubation period between exposure and onset of symptoms varies from two years to many decades, though death occurs within one year of the onset of symptoms. CJD is not related to BSE, or mad cow disease. ● Brucella species (brucellosis). ● Brucellosis (Brucella species). ● Burkholderia mallei (glanders). ● Burkholderia pseudomallei (melioidosis). ● Chlamydia psittaci (psittacosis). ● Cholera (Vibrio cholerae). ● Clostridium botulinum toxin (botulism). ● Clostridium perfringens (Epsilon toxin). ● Coxiella burnetii (Q fever). Variant CJD (vCJD) is not the same disease as classic CJD. It has different clinical and pathologic characteristics from classic CJD. Each disease also has a particular genetic profile of the prion protein gene. Variant Creutzfeldt-Jakob disease (vCJD) is a prion disease that was first described in 1996 in the United Kingdom. There is now strong scientific evidence that the agent responsible for the outbreak of prion disease in cows, BSE, is
● Neisseria gonorrhoeae. ● Multidrug-resistant Acinetobacter. ● Drug-resistant Campylobacter. ● Fluconazole-resistant Candida. ● Extended Spectrum beta-lactamases (ESBL). ● Vancomycin-resistant enterococci (VRE). ● Multidrug-resistant Pseudomonas aeruginosa. ● Drug-resistant non-typhoidal Salmonella. ● Drug-resistant Salmonella Serotype Typhi. ● Drug-resistant Shigella. ● Methicillin-resistant Staphylococcus aureus (MRSA). ● Drug-resistant Streptococcus pneumoniae. ● Drug-resistant Tuberculosis. ● Vancomycin-resistant Staphylococcus aureus. ● Erythromycin-resistant Group A Streptococcus. ● Clindamycin-resistant Group B Streptococcus. ● Food safety threats (e.g., Salmonella species, Escherichia coli O157:H7, Shigella). ● Francisella tularensis (tularemia). ● Glanders (Burkholderia mallei). ● Lassa fever. ● Marburg virus hemorrhagic fever. ● Melioidosis (Burkholderia pseudomallei). ● Psittacosis (Chlamydia psittaci). ● Q fever (Coxiella burnetii). ● Ricin toxin from Ricinus communis (castor beans). ● Viral encephalitis (alphaviruses such as Venezuelan equine encephalitis, eastern equine encephalitis, western equine encephalitis). ● Viral hemorrhagic fevers (filoviruses including Ebola, Marburg, and arenaviruses such as Lassa, Machupo). ● Water safety threats including Vibrio cholerae, Cryptosporidium parvum. proteins are still not completely understood, but the abnormal folding of the prion proteins leads to brain damage and the characteristic signs and symptoms of the disease. Prion diseases are usually rapidly progressive and always fatal. Prion diseases in animals include scrapie in sheep and goats; bovine spongiform encephalopathy (BSE), or “mad cow disease” in cattle; and chronic wasting disease in deer and elk. BSE, first recognized in the United Kingdom (UK) in 1986, was associated with a major epidemic among cattle that had consumed contaminated meat and bone meal. ● Rickettsia prowazekii (typhus fever). ● Salmonella species (salmonellosis). ● Salmonella Typhi (typhoid fever). ● Salmonellosis (Salmonella species). ● Shigella (shigellosis). ● Staphylococcal enterotoxin B. ● Typhoid fever (Salmonella Typhi). ● Typhus fever (Rickettsia prowazekii). ● Vibrio cholerae (cholera). the same agent responsible for the outbreak of vCJD in humans. Both CJD and vCJD disorders are fatal brain diseases with unusually long incubation periods measured in years, and are caused by a prion. Although most cases of CJD have been reported from the UK, cases also have been reported from other parts of Europe, Japan, Canada, and the United States. Standard Precautions are used when caring for clients with suspected or confirmed CJD. This course includes special precautions from the CDC and WHO for tissue handling, contact with a body after autopsy, embalming, and reprocessing surgical instruments to prevent transmission of CJD.
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