ES Infection Prevention Challenges: Fighting Antibiotic-Resistant Bacteria and Emerging Viral Pathogens

By Strazdas, Lori | Health Facilities Management, July 2017 | Go to article overview

ES Infection Prevention Challenges: Fighting Antibiotic-Resistant Bacteria and Emerging Viral Pathogens


Strazdas, Lori, Health Facilities Management


Today's health care facilities need environmental infection control strategies that can address a range of threats, from the most common health care-associated infection (HAI)-causing pathogens like Clostridium difficile to emerging antibiotic-resistant bacteria and viral pathogens.

In late February 2017, the World Health Organization (WHO) published its first-ever priority pathogens list, a catalog of 12 families of antibiotic-resistant bacteria that pose the greatest threat to human health.

Environmental services (ES) professionals must take this list as well as other unlisted threats under consideration as they develop a cleaning and disinfection program for their organizations.

Antibiotic-resistance issues

The WHO list is broken up into three categories:

Critical priorities: carbapenem-resistant Acinetobacter baumannii; carbapenem-resistant Pseudomonas aeruginosa; and carbapenem-resistant, extended-spectrum beta lactamase-producing Enterobacteriaceae.

High priorities: vancomycin-resistant Enterococcus faecium; methicillin-resistant, vancomycin-intermediate and resistant Staphylococcus aureus; clarithromycin-resistant Helicobacter pylori; fluoroquinolone-resistant Campylobacter spp.; fluoroquinolone-resistant Salmonella; and cephalosporin-resistant and fluoroquinolone-resistant Neisseria gonorrhoeae.

Medium priorities: penicillin-non-susceptible Streptococcus pneumoniae; ampicillin-resistant Haemophilus influenzae; and fluoroquinolone-resistant Shigella spp.

While the WHO's list of priority pathogens was welcomed by many leading health care organizations and experts in infectious diseases, epidemiology, biodefense and public health, who have endorsed its goals, there is not perfect agreement on which pathogens warrant a spot on the list and how they are prioritized.

Take, for example, the Infectious Diseases Society of America (IDSA). The WHO list included three carbapenem-resistant pathogens--A. baumannii, P aeruginosa and Enterobacteriaceae--that the IDSA had recommended as the highest priorities, as "critical," but left off others.

In an October 2016 letter to the director general of the WHO, the IDSA maintained that other ESKAPE (E. faecium, S. aureus, Klebsiella pneumoniae, A. baumannii, P. aeruginosa and Enterobacter species) pathogens, which continue to pose serious threats globally, as well as bacteria that carry mcr-1 or mcr-2 genes and convey colistin resistance, also should be considered among the highest priorities.

The IDSA also argued that multidrug --resistant tuberculosis remains a significant global threat, but it was left off the WHO's list because the organization determined that it is targeted by other dedicated programs.

The WHO's priority pathogen list is also not the only major initiative in recent years urging world leaders to address antimicrobial resistance and call for greater public and private-sector engagement to combat this urgent threat.

In 2013, the Centers for Disease Control and Prevention (CDC) published a report outlining the top 18 drug-resistant threats to the United States, with each pathogen categorized based on level of concern, from urgent to serious and concerning.

The European Centre for Disease Prevention and Control and Asian Network for Surveillance of Resistant Pathogens also have undertaken antibiotic-resistance threat assessments.

Dynamic response required

While the findings of these reports may vary, one thing is clear: Antibiotic resistance is a challenge that requires a dynamic response to account for both familiar and evolving threats. As the U.S. continues to build on existing and ongoing efforts to combat antibiotic resistance, it is useful to consider the three core areas the CDC has identified as priorities for strategic investment to protect patients:

Detection and response. The ability to identify and respond quickly to outbreaks and emerging threats, from HAIs to growing antibiotic resistance, is crucial to containing these threats and controlling their spread. …

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