as part of their Infection Prevention and Control Conditions of Participation (CMS, 2019; CMS, 2022). To help facilities develop a program, the CDC published the Core Elements of an Antibiotic Stewardship Program for Hospitals, Outpatient Settings, Nursing Homes, and Resource- Limited Settings (CDC, 2021). Antimicrobial stewardship programs aim to reduce infections, reduce antibiotic use, and find opportunities for improvement. The CDC has a national campaign called Be Antibiotics Aware , which is a patient safety campaign for providers to help educate their patients on appropriate antibiotic use (CDC, 2021). The CDC recently released a special report on the COVID-19 pandemic’s effect on antimicrobial resistance improvement efforts (CDC, 2022). The pandemic not only caused increasing infections (which means an increase in antibiotic use) but also increased the difficulty of adhering to infection prevention and control guidance. Due to the challenges experienced during the pandemic, the CDC is planning to support improved public health infrastructure (testing, monitoring, vaccination, education) regarding antimicrobial resistance and emerging threats. Emerging threats are from pathogens such as Candida auris , Multidrug-resistant organisms (MDROs) The CDC published guidance for the management of multidrug- resistant organisms in healthcare settings (2006), which provides background and epidemiological information about MDROs, their clinical importance, and infection prevention and control measures to help prevent transmission. Since emerging resistant pathogens exist, a prompt response to contain an MDRO in a healthcare facility requires a structured approach. Healthcare Agents of bioterrorism Examples of bioterrorism agents include anthrax, smallpox, plague, tularemia, viral hemorrhagic fevers, and botulism. These agents are easily transmitted from person to person (CDC, 2020). Healthcare facilities should have policies and plans for Transmission-based precautions Transmission-based precautions (TBP) are an evidence-based approach to minimize pathogen transmission in healthcare settings. There are different precaution types (airborne, droplet, and contact) depending on the healthcare setting and how the pathogens are transmitted. Multidrug-resistant bacteria are considered urgent threats to public health; therefore, all HCWs should be trained in these threats and know how to protect themselves and their patients. Healthcare workers should know where pathogen reservoirs are, how pathogens are transmitted, and actions to take to reduce transmission. The CDC published the 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings , which describes standard and TBP (CDC, 2022). The precaution types are implemented in addition to standard precaution, because the route of transmission is not completely interrupted with just standard precautions. The precaution type will determine the recommended PPE (gowns, gloves, masks, and face shields or goggles) to wear to prevent transmission to self and other vulnerable patients. Transmission-based precautions generally apply to healthcare settings. While the risk is not clearly defined, HCWs in ambulatory and home care settings should follow standard precautions and wear appropriate PPE while caring for patients. Transmission-based precautions are used for patients known or suspected to be infected or colonized with an infectious agent (CDC, 2022) and are a short-term strategy. The difference between infection and colonization is that a patient with an infection has an abundance of microorganisms causing illness, whereas colonization does not produce clinical symptoms. To reduce potential transmission, transmission-based precautions are implemented while test results are pending.
carbapenem-resistant Acinetobacter , C. difficile , carbapenem- resistant Enterobacterales , and multidrug-resistant Pseudomonas aeruginosa. Healthcare Consideration: A Complex Web: Everything Is Connected In healthcare facilities, everything is connected, which creates a pathway for resistant bacteria to spread. Antibiotics can save lives; however, organisms can develop antibiotic resistance, which can harm patients. Certain resistant bacteria survive in plumbing (e.g., sink drains) and the environment (e.g., bedrails) and can splash onto people and the environment or move to the wastewater stream. These bacteria can also survive on medical devices, creating a pathway into the patient’s body and causing an infection. These resistant bacteria can spread if patients are colonized and move throughout the healthcare facility without appropriate infection control practices. Patients with these resistant bacteria get discharged from the hospital and go home and use the waste stream (stool). If the resistant bacteria get into the waste stream, this ends up spreading the resistant bacteria to the environment through bodies of water (lakes and streams) (CDC, n.d.a). facilities should collaborate with local and/or state public health departments to guide a novel or targeted MDRO campaign (CDC, 2019). Some more familiar MDROs include methicillin- resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and extended-spectrum beta-lactamase (ESBL)–producing organism.
emergencies, including those related to agents of bioterrorism. Bioterrorism resources can be found on the CDC Bioterrorism webpage: https://emergency.cdc.gov/bioterrorism/index.asp.
Airborne precautions Airborne precautions prevent the transmission of infectious pathogens of small droplet size, which remain infectious over long distances when suspended in the air (CDC, 2022). A negative pressure airborne infection isolation room (AIIR) is the preferred room placement. Recommended PPE include a mask or respirator (i.e., N95), depending on the disease- specific recommendations. To limit exposure, don PPE before entering the patient’s room and remove it after exiting the patient’s room. Patients who are transported out of their room should wear a mask (if tolerated) and follow respiratory hygiene/cough etiquette. Examples of pathogens that require airborne precautions are rubeola virus (measles), varicella virus (chickenpox), Mycobacterium tuberculosis (TB), and (for certain Droplet precautions prevent the transmission of infectious pathogens of large droplet size, which spread through close respiratory or mucous membrane contact (CDC, 2022). Beyond three feet, these large droplets do not remain infectious, and gravity pulls them down to the ground; therefore, special air handling and ventilation are not required. The PPE recommended is a mask (a respirator is not necessary) for close contact with an infectious patient. Don PPE upon room entry and remove it after exiting the patient’s room. Patients transported out of their room should wear a mask (if tolerated) and follow respiratory hygiene/cough etiquette. Contact precautions Contact precautions prevent the transmission of infectious pathogens by direct or indirect contact with the patient or the patient’s environment (CDC, 2022). Contact precautions are implemented when caring for a patient with excessive wound situations) SARS-CoV. Droplet precautions
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