Thursday, February 19, 2015

Carbapenem-resistant Enterobacteriaceae, bacteria on endoscopes in news and is great threat globally, written by Gloria Poole,RN,artist of Missouri

Today I read an article in the L A Times about carbapenem-resistant Enterobacteriaceae, and thought to myself that I might research it some to add info for the public. So here is a summary of many documents and I have included links to the whole articles.
"CRE, which stands for carbapenem-resistant Enterobacteriaceae, are germs that have become too difficult to treat because they are resistant to most antibiotics. " and they are on endoscopes.

For more info  I accessed the National Institute of Health's search tool and found several articles on research into that bacteria. : discusses the various antibiotics that are effective against carbapenem-resistant Enterobacteriaceae,. 
Quote : "The emergence of carbapenem resistance in Enterobacteriaceae is an important threat to global health. Reported outcomes of infections with carbapenem-resistant Enterobacteriaceae (CRE) are poor. Very few options remain for the treatment of these virulent organisms." And treatment : "Antibiotics which are currently in use to treat CRE infections include aminoglycosides, polymyxins, tigecycline, fosfomycin, and temocillin." And : n the USA, associated annual additional costs of infections caused by resistant organisms as compared to susceptible organisms are estimated between $21 billion and $34 billion (Spellberg et al., 2011). The Infectious Diseases Society of America (IDSA) recognizes antimicrobial resistance as “one of the greatest threats to human health worldwide” (Spellberg et al., 2011). In addition, antimicrobial resistance was the focus of the 2011 World Health Day of the World Health Organization (WHO). The impact of multidrug resistance (MDR) extends into all aspects of medicine and threatens the significant progress which has been made in transplantation, oncology, and surgery. Understandably, much emphasis has been appropriately placed on methicillin-resistant Staphylococcus aureus (MRSA). In recent years, several new treatment options have become available for MRSA. In addition, true vancomycin resistance remains fortunately rare. However, the threat of MDR in Gram-negative organisms has not led to a similar increase in novel therapeutics. The prevalence of carbapenem resistance in Enterobacteriaceae (CRE) isolated from clinical samples continues to increase globally (Prabaker and Weinstein, 2011; Rhomberg and Jones, 2009; van Duijn et al., 2011)."

And it seems there is link between CRE and Klebsiella Pneumoniae : "Over the past 10 years, dissemination of Klebsiella pneumoniae carbapenemase (KPC) has led to an increase in the prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in the United States. Infections caused by CRE have limited treatment options and have been associated with high mortality rates." Entire article at 

I also researched the protocols that operating rooms are supposed to use in disinfecting endoscopes. Endoscopes cannot be sterilized in the same way as metal tools because they are lasers inside of flexible tools that drill down into body parts. And the disinfection regimen must be followed exactly ´VERY TIME. There are several websites on this topic but I prefer the CDC guidelines. That is probably because I worked as Registered Nurse in operating rooms in Atlanta, GA metro area and other states' also, but I actually visited the CDC in Atlanta GA [as an RN]  and know of their caliber.

Disinfecting endoscopes protocols:
and also :
and also :
Most helpful for medical people is : with "reprocessing [re-use] of endoscopes as section to be read carefully by those who work in operating rooms with quote : "more healthcare–associated outbreaks have been linked to contaminated endoscopes than to any other medical device" and "Because of the types of body cavities they enter, flexible endoscopes acquire high levels of microbial contamination (bioburden) during each use ." And : "On the basis of these data, APIC 113, the Society of Gastroenterology Nurses and Associates (SGNA) 38, 114, 115, the ASGE 108, American College of Chest Physicians 12, and a multi-society guideline 116 recommend alternative contact conditions with 2% glutaraldehyde to achieve high-level disinfection (e.g., that equipment be immersed in 2% glutaraldehyde at 20oC for at least 20 minutes for high-level disinfection). Federal regulations are to follow the FDA-cleared label claim for high-level disinfectants. The FDA-cleared labels for high-level disinfection with >2% glutaraldehyde at 25oC range from 20-90 minutes, depending upon the product based on three tier testing which includes AOAC sporicidal tests, simulated use testing with mycobacterial and in-use testing.The studies supporting the efficacy of >2% glutaraldehyde for 20 minutes at 20ºC assume adequate cleaning prior to disinfection, whereas the FDA-cleared label claim incorporates an added margin of safety to accommodate possible lapses in cleaning practices. Facilities that have chosen to apply the 20 minute duration at 20ºC have done so based on the IA recommendation in the July 2003 SHEA position paper, "Multi-society Guideline for Reprocessing Flexible Gastrointestinal Endoscopes" 19, 57, 83, 94, 108, 111, 116-121.  
Also, merely soaking the endoscopes in disinfectant is NOT enough. There are five steps involved in cleaning them for re-use and each step must be done, including the drying time.

"And : "In general, endoscope disinfection or sterilization with a liquid chemical sterilant involves five steps after leak testing:

1) Clean: mechanically clean internal and external surfaces, including brushing internal channels and flushing each internal channel with water and a detergent or enzymatic cleaners (leak testing is recommended for endoscopes before immersion).
2) Disinfect: immerse endoscope in high-level disinfectant (or chemical sterilant) and 
3) perfuse (eliminates air pockets and ensures contact of the germicide with the internal channels) disinfectant into all accessible channels, such as the suction/biopsy channel and air/water channel and expose for a time recommended for specific products.
4) Rinse: rinse the endoscope and all channels with sterile water, filtered water (commonly used with AERs) or tap water (i.e., high-quality potable water that meets federal clean water standards at the point of use).
5) Dry: rinse the insertion tube and inner channels with alcohol, and dry with forced air after disinfection and before storage.
Store: store the endoscope in a way that prevents recontamination and promotes drying (e.g., hung vertically). Drying the endoscope (steps 3 and 4) is essential to greatly reduce the chance of recontamination of the endoscope by microorganisms that can be present in the rinse water 116, 156.  One study demonstrated that reprocessed endoscopes (i.e., air/water channel, suction/biopsy channel) generally were negative (100% after 24 hours;"

I am posting this information here in an effort to improve the global public health. Not all bona-fide ambulatory surgery places have guidelines for sterilizing invasive scopes. Metal surgical tools have their own set of sterilization guidelines.

I also tweet about this blog with hashtags : #publichealth, #gloriapoole; #ProlifeNurse; #gloria_poole but usually not all at the same time. You can follow me on twitter on sveral twitter accts of mine but the ones that often include medical facts or info are @ProlifeNurse; @personhood1.

Statement of ownership: this blog is owned entirely by me Gloria Poole,RN, artist of Missouri. I began this blog during a disastrous 2nd marriage that ended in divorce in Oct 2007 from male DBP, after 4 horrible years of trauma and injury and terror to me,;and I removed the Pappas name from my name at the time of final divorce decree. That divorce is public record in the state of Colorado. I moved to Missouri in Oct 2009, and continued my #prolife blogging and my efforts to promote #personhood for all people including those in the womb.
Below are symbols that represent me:

This is my signature for my 2015 personal logo. I have not yet made one for my RN logo. 

This is my hand on one of my Christian cross necklaces to remind all that I am Southern Baptist believer and do not make nor worship images of GOD in accordance with Exodus chapter 20, KJV. 

This is my photo of the U S flag to remind all that I am US citizen born in state of Georgia with all civil liberties including freedom of press and freedom to worship GOD; and freedom to protest governments. 
Copyright notice 7 February 2015 at 12:36pm: This blog and all content, all words, all photos and all art on it were created and posted by me Gloria Poole , RN, artist of Missouri and Georgia. Usually I sign the art I create as simply Gloria since that is my first name I was born with but occasionally I also sing my born with surname of Poole [and if I was married my then married surname ]. . I am also known on the web and in real life as Gloria Poole; Gloria J Poole; Gloria Poole, RN, artist; and on the web as : gloriapoole; gloria-poole; gloria.poole; Ms Gloria Poole; gloriapoole.RN; gloriapoole_RN; gloriapooleRN at yahoo; gloria0817; gpoole817; artist-gloriapoole; gloriapoole-paintings; artist-gloria; Poole,Gloria; gloriapoole1749; and other variations of my real, born with, and legal name of Gloria Poole. For the record, I am a white, twice divorced Christian woman and the mother of two grown daughters who are named Jennifer and Leigh. I am also a prolife activist, blogger, artist in all mediums; photographer for my own purposes, Registered Nurse with a license in Missouri but before that for most of my life in the state of Georgia,  U.S. citizen born in the state of Georgia; University of Georgia alum, Georgia Baptist College of Nursing alum, writer, illustrator, author. This blog may not be downloaded, nor copied individually or collectively as a whole; nor have domains forwarded to it that do not belong to me, nor may the photos or art on it be reproduced or saved to disk by anyone . I create all content on this blog and I, Gloria Poole, own all rights to this blog collectively and individually as single posts. The telephones listed on this account belong to me and are in my apartment in Missouri or in my possession at all times. Some of my numbers are wired, landline telephones and some are mobile phones. This blog and all blogs that I create and that contain my words and or art and or photos that I create bel*og exclusively to me Gloria Poole, of Missouri and Georgia. Copyright. Gloria Poole /gloriapoole /gloria-poole /gloria.poole/ Ms Gloria Poole/ Poole Gloria at my apt in Missouri on 7 Feb 2015 at 12:45pm which is not shared with anyone and neither is my equipment nor phones shared with anyone, and nether is my sip account shared with anyone. Gloria Poole, RN, artist; at my apt in Missouri  on 19 Feb 2015 at 2:18pm.