Superbug CRE: Can Healthcare Facility Design Protect Patients And Staff?
The germs are getting stronger. On March 5, the Centers for Disease Control and Prevention held a press conference on carbapenem-resistant enterobacteriaceae—CRE—and the threat these deadly bacteria pose to patients and staff in healthcare facilities. Taking steps to keep CRE out of the community at large is a top priority.
“It's not often that our scientists come to me to say that we have a very serious problem, and we need to sound an alarm,” said CDC director Dr. Tom Frieden. “CRE are nightmare bacteria. … They're resistant to all or nearly all antibiotics—even some of our last-resort drugs. They have high mortality rates; they kill up to half of people who get serious infections with them. And they can spread their resistance to other bacteria.” Frieden urged healthcare workers and facilities to take every measure to stop the infection from spreading: “We only have a limited window of opportunity to stop this.”
Infection control has always been high on the list of concerns for healthcare facilities, and the shift from “concern” to “alarm” seems to be happening all too frequently today as more and more bacteria develop antibiotic-resistant capabilities. Infections from this new superbug have a staggering death rate. The emergence of one type of CRE, klebsiella pneumoniae, reportedly jumped 550 percent (from 1.6 percent to 10.4 percent) between 2001 and 2011. Klebsiella pneumoniae was part of an outbreak that spread through the National Institutes of Health Clinical Center near Washington, D.C., last summer, killing seven people, including a teenage boy.
Gary Roselle, director of the Infectious Diseases Service for the Department of Veterans Affairs healthcare system, told USA Today: “If you look at the current pipeline of antibiotics [in development] … none of them really is going to be active against these bacteria.” CRE infections, he says, “are remarkably difficult to treat, [and] they often have bad outcomes. I'm assuming this is going to get worse, and there likely won't be new antibiotics to treat it in the near future, so the focus has to be on prevention.”
Prevention is something those in our industry can help with. Relentless handwashing, of course, is the first thing on the list for thwarting the spread of all kinds of healthcare-associated infections (HAIs). While an architect or designer can’t really keep tabs on how often Nurse Smith, Dr. Brown, or even Grandma Visitor scrubs up, he or she can create a patient room layout that locates the sink in an optimal place for frequent use. The facility manager and engineering team can make sure the faucet operates on a no-hands basis and the water maintains the proper germ-killing (but skin-sensitive) temperature.
Beyond handwashing, the design of facilities’ plumbing and HVAC systems can do a lot to curtail the spread of both waterborne and airborne germs that cause HAIs. The choice of materials for everything from privacy curtains to wallcoverings to handrails can play a significant role, as well, when designers stay on top of the research and specify materials with antimicrobial properties.
The CDC’s Frieden is calling for a “detect and protect” strategy to stop the spread of CRE. It’s important to remember our industry’s role in the “protect” part, and do everything we can to contribute.