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The page below is a sample from the LabCE course Drug-Resistant Superbugs, Multi-drug Resistant Organisms: MRSA, VRE, Clostridium difficile, and CRE. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Control of CRE

The best course of action against CRE is to prevent transmission in the first place. The CDC indicated in the January 13, 2017 issue of the Morbidity and Mortality Weekly Report (MMWR) three important issues with regard to the control of CRE:
  1. The number of isolates resistant to all antibiotics remains very uncommon.
  2. Effective infection control contact precautions should be instituted when CRE are identified in order to slow the spread of organisms with resistance mechanisms of the greatest concern.
  3. Healthcare facilities should consider screening for CRE when a patient has a recent history of healthcare exposure outside the United States or in a region with a known higher incidence of CRE.
The CDC provides regularly updated resources to help protect patients and prevent transmission, including two toolkits*:
  • Facility Guidance for Control of Carbapenem Resistant Enterobacteriaceae (CRE) - November 2015 Update CRE Toolkit
  • Carbapenemase-Producing Enterobaceriaceae (CRE) Control and Prevention Toolkit
To maximize efforts, all MDRO control strategies require cooperation within each facility and between state and local health departments. Guidelines include:
  • Enforcing enhanced hand hygiene compliance
  • Placing CRE-colonized or CRE-infected patients on contact isolation precautions
  • Minimizing the use of invasive medical devices
  • Utilizing a designated nursing staff to work with colonized or infected patients
  • Promoting antibiotic stewardship
  • Screening patients with risks for CRE
In areas where CRE is endemic, the CDC recommends that healthcare facilities also:
  • Implement active surveillance for CRE
  • Use chlorhexidine bathing or wipes
*Both toolkits are available at: https://www.cdc.gov/hai/organisms/cre/cre-toolkit/. Accessed June 21, 2018.