Natural and m an made disasters


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Natural and m an made disasters

  1. 1. Agents of Terrorism
  2. 2. Terrorism • Dispensing of disease pathogens (bioterrorism) or other agents (chemical, nuclear, radioactive, explosive devices) to express harm 2
  3. 3. Inhalation Anthrax • Bacillus anthracis: spores multiply in the lungs • Causes hemorrhage and destruction of lung tissue • S/sx: dyspnea, cough, chest pain • Tx: ATB 3
  4. 4. Cutaneous anthrax • • • • 95% of anthrax infections Spores enters thru skin Toxins destroy surrounding tissues s/sx: small papule resembling insect bite, depressed black ulcer, swollen lymph nodes 4
  5. 5. Smallpox • Variola major and minor viruses • Highly contagious, droplet • S/sx: fever, HA, myalgia, papules to pustular vesicles • Tx: No known cure, Cidofovir (exp), vaccination (Vaccinia immune globulin) 5
  6. 6. 6
  7. 7. Botulism • • • • Clostridium botulinum Spore forming anaerobe (soil) Lethal bacterial neurotoxin; can die in 24hrs S/sx: abd cramps, diarrhea, n/v, cranial nerve palsies, resp failure • MOT: air or food (contaminated wound or improperly canned food) • Antitoxin, vomiting, PCN, enemas 7
  8. 8. Plague • • • • Bacteria found in rodents and fleas Bubonic, pneumonic, septicemic Hemotypsis, cough, high fever, resp failure Tx: ATB (aminoglycosides) 8
  9. 9. Hemorrhagic fever • Ebola virus, Lassa virus • Fever, conjunctivitis, hemorrhage of tissues and organs, n/v, hypotension • Rodents and mosquitoes, virus can be aerolized • NO Tx; Isolate, Ribavirin (effective at times) 9
  10. 10. Chemical Agents of Terrorism • Sarin: highly toxic nerve gas - Enters thru eyes and skin paralyzing resp muscles - Antidote: Atropine sulfate • Phosgene - Colorless gas causing resp distress • Mustard gas: yellow brown color; garlic like odor - Irritates the eyes and causes skin burns and blisters 10
  11. 11. Ionizing radiation • Nuclear bomb or nuclear reactor explosion • If with external contamination: decontamination procedures should be done • Acute radiation syndrome develops after substantial exposure • Depends upon the amount of radiation • 0-100 rad, 100-200rad, 200-600rad, 600-800rad, 8003000rad, >3000rad 11
  12. 12. 12
  13. 13. BLAST INJURIES • Bombs and explosions can cause unique patterns of injury seldom seen outside combat • Expect half of all initial casualties to seek medical care over a one-hour period • Most severely injured arrive after the less injured, who bypass EMS triage and go directly to the closest hospitals • Predominant injuries involve multiple penetrating injuries and blunt trauma • Explosions in confined spaces (buildings, large vehicles, mines) and/or structural collapse are associated with greater morbidity and mortality 13
  14. 14. BLAST INJURIES TYPES • •Primary: Injury from over-pressurization force (blast wave) impacting the body surface — TM rupture, pulmonary damage and air embolization, hollow viscus injury 14
  15. 15. • Secondary: Injury from projectiles (bomb fragments, flying debris) — Penetrating trauma, fragmentation injuries, blunt trauma 15
  16. 16. • • Tertiary: Injuries from displacement of victim by the blast wind — Blunt/penetrating trauma, fractures, and traumatic amputations 16
  17. 17. • Quaternary: All other injuries from the blast — Crush injuries, burns, asphyxia, toxic exposures, exacerbations of chronic illness 17
  18. 18. DIAGNOSTIC EVALUATION • Document amusculoskeletal, neurological, and vascular exam for each extremity • Extremities should be thoroughly evaluated from a vascular perspective • Each open wound should be well documented—noting size, exposed bone, and type of contamination—and, ideally, photographed • X-rays of injured extremities should be utilized to identify deep foreign bodies and to characterize bony injuries • Also, the absence of external injuries never rules out internal organ damage due to blunt trauma or blast wave injuries 18
  19. 19. INITIAL MANAGEMENT • Lung Injury – Signs usually present at time of initial evaluation, but may be delayed up to 48 hours – Reported to be more common in patients with skull fractures, >10% BSA burns, and penetrating injury to the head or torso – Varies from scattered petechiae to confluent hemorrhages – Suspect in anyone with dyspnea, cough, hemoptysis, or chest pain following blast – CXR: “butterfly” pattern – High flow O2 sufficient to prevent hypoxemia via NRB mask, CPAP, or ET tube 19
  20. 20. • Crush Injury and Crsuh Syndrome – Due to increased muscle breakdown – Crush syndrome can cause local tissue injury, organ dysfunction, and metabolic abnormalities, including acidosis, hyperkalemia, and hypocalcemia – Manage initially with IV fluids and maintain hydration – Compartment syndrome, rhabdomyolysis, and acute renal failure are associated with structural collapse, prolonged extrication, severe burns, and some poisonings 20
  21. 21. • Abdominal Injury – Gas-filled structures most vulnerable (esp. colon) – Bowel perforation, hemorrhage (small petechiae to large hematomas), mesenteric shear injuries, solid organ lacerations, and testicular rupture – Suspect in anyone with abdominal pain, nausea, vomiting, hematemesis, rectal pain, tenesmus, testicular pain, unexplained hypovolemia – Keep patient NPO until properly assessed in a medical facility 21
  22. 22. • Traumatic Brain Injuries – Check GCS, observe for any lucid interval, CSF leaks – Concussions are common and easily overlooked • Ear Injury – Tympanic membrane most common primary blast injury – Signs of ear injury usually evident on presentation (hearing loss, tinnitus, otalgia, vertigo, bleeding from external canal, otorrhea) – Can cause problems in communication – provide a pen and paper 22
  23. 23. INITIAL MANAGEMENT • Extremity Injuries – Tourniquet and pressure especially for amputees – Traumatic amputation of any limb is a marker for multisystem injuries • Eye Injuries – Significant percentage of survivors will have serious eye injuries – Cover both eyes in case of injury, but use a convex plastic or eye shield, do not remove foreign objects! 23
  24. 24. • Thermal Injuries – Rule of nines, ABCs, and IVF replacement – Consider possibility of exposure to inhaled toxins (CO, CN, MetHgb) in both industrial and terrorist explosions • Other Injury – Consider delayed primary closure for grossly contaminated wounds, and assess tetanus immunization status 24
  26. 26. Notification System An alarm system of one kind or the other must be in place to notify the staff and patients of a fire. This may include one or more of the following: • Public Address system (PA) • Alarm Pull Stations • Voice – call out fire, “Code Red” etc. 26
  27. 27. Means of Egress • A continuous and unobstructed way of exit travel from a building or structure. • Egress must be unobstructed and unlocked while the structure is occupied. 27
  28. 28. Emergency Exits • All exits must be clearly visible – no mirrors, curtains, or other camouflage. • All exits must be clearly illuminated • Doors which may be mistaken as exits must be clearly labeled as “Not an Exit.” 28
  29. 29. Fire Doors – Door stops, wedges and other unapproved holdopen devices are prohibited on fire doors – Swinging fire doors shall close from the full-open position and shall latch automatically NO!!! 29
  30. 30. Building Evacuation • Proceed to nearest exit in an orderly fashion, closing doors behind you. • Assemble at the designated meeting location and account for all patients, visitors, and staff. • Provide safety representatives with information about people still in the building. • Never re-enter a building until instructed to by the police department or fire department 30
  31. 31. RACE Method Of Evacuation • R Remove All Persons In Danger! • A Always Pull The Alarm; • C Contain The Fire By Closing the Windows and Doors. • E Extinguish the Fire Only if You Are Trained and Confident. 31
  32. 32. Emergency Procedures • Staff members should have specific roles in equipment shutoff. • All doors should be checked for visitors and shut on the way out in order to contain smoke and fire. 32
  33. 33. Patient Evacuation  All patients should be escorted to the designated meeting location immediately after the alarm sounds.  A staff member should remain with patients at all times. 33
  34. 34. Patient Evacuation • Each institution must develop a procedure to account for all patients at the meeting location. • One example is for a staff member working at the front desk to bring the patient checkin sheet to the meeting location. 34
  35. 35. Emergency Evacuation Plan • All employees should have read the Emergency Evacuation Plan (EEP) and fully understand it. • It is important to update Safety Representatives and contacts whenever a change is made. • The meeting locations should be away from any traffic areas that might be a danger. 35
  36. 36. Training • All faculty and staff should be trained on emergency evacuation plans and participate in scheduled drills. • This training should be updated annually and/or when staff or the facility changes. 36
  37. 37. Common Causes of Fires in Health Care Facilities • • • • • • • Electrical Malfunctions Friction Open Flames Sparks Hot Surfaces Compressed O2 Anesthetic Gases 37
  38. 38. Precautions Against Fire • Extension cords and flexible cords cannot be a substitute for permanent wiring. • Regularly inspect electrical cords for damage. • Use caution when working with open flames or hot surfaces. 38
  39. 39. Electrical Safety • Surge Protectors are the only approved means of multiplying a receptacle. • Some parts of this extension cord are approved, the problem is that it is not approved as a unit. • All appliances must have a UL label. 39
  40. 40. How Does a Fire Work? • Three components • Need all three components to start a fire • Fire extinguishers remove one or more of the components • Oxygen is required as a catalyst – may come from the air OR from the fuel itself • Fire extinguishers are used to ‘extinguish’ one of the three components that allow the fire to exist. 40
  41. 41. Portable Fire Extinguishers • Locate and identify extinguishers so that they are readily accessible. • Only approved extinguishers shall be used. • Maintain extinguishers in a fully charged and operable condition. 41
  42. 42. Classification of Fires & Extinguishers Class A Fires Wood Paper Rags Some rubber and plastic materials 42
  43. 43. Classification of Fires & Extinguishers Class B Fires  Gasoline  Oil  Grease  Paint  Flammable Gases  Some rubber and plastic materials 43
  44. 44. Classification of Fires & Extinguishers Class C Fires  Electrical Fires – Office Equipment – Motors – Switchgear – Heaters 44
  45. 45. Classification of Fires & Extinguishers Class D Fires Metals – Magnesium – Titanium – Sodium – Zirconium – Potassium – Lithium 45
  46. 46. Multi-Class Ratings • There are several types of multi-class extinguishers: A-B, B-C, or A-B-C. • Be sure the correct extinguisher is provided for the hazards. NOT for Electrical Equipment fires • Generally, ABC combinations are used at to extinguish a wide variety of fires including: Combustibles, Flammable Liquids, and Electrical Fires. 46
  47. 47. Different Kinds of Extinguishers –All Purpose Water –Carbon Dioxide –Multi-Purpose Dry Chemical –Dry Powder Water Carbon Dioxide 47
  48. 48. How to Use an Extinguisher PAS S P: Pull the pin. A: Aim extinguisher nozzle at the base of the flame. S: Squeeze trigger while holding the extinguisher upright. S: Sweep the extinguisher from side to side, covering the area with the extinguisher agent. 48
  49. 49. Fire Extinguishers Inspection, Maintenance and Testing • Visually inspected monthly • Maintained annually • Hydrostatically tested periodically (5 or 12 yrs.) 49
  50. 50. Partnership with Red Cross • Pre-fire planning • Campus building surveys • Training / Education 50
  51. 51. Do You Know??? • Where is the nearest fire alarm pull station? • Where is the nearest fire extinguisher? • Where are the primary and secondary exits? • Where are the primary and secondary designated meeting locations? • Where is the emergency procedures manual? • What is your specific role in patient evacuation and emergency equipment shut-off? 51
  52. 52. 52
  53. 53. Earthquake • Most destructive and frightening of all forces of nature • Caused by breaking and shifting of rock beneath the earth’s surface • Richter scale: measures the magnitude and intensity or energy released by the quake 53
  54. 54. Instrument which measures and detects seismic waves/vibrations Weight and pen remain still during an earthquake; drum moves with the Earth Earthquake measuring stations have at least 3 seismographs Locations of epicenters are determined using data from 3 measuring stations Photo courtesy of :
  55. 55. Written record of earthquake waves Used to determine epicenter and when earthquakes occurred Shows magnitude (strength) of waves with height of lines
  56. 56. Epicenter: surface origin of seismic waves (surface waves) directly above focus Focus: underground point of origin for earthquake body waves
  57. 57. Why do you need 3 stations reporting the same earthquake data? Triangulation results in one epicenter location.
  58. 58. •Strength/Energy released by an earthquake •Measured by Richter Scale •Scale from 0-10 •Each increasing number is 10x more ground shaking •A measure of how much damage is done and the degree to which an earthquake is felt by people •Measured by Modified Mercalli Scale •Scale from I-XII •Each location that felt the event will have a different intensity level
  59. 59. Liquefaction Vibrations cause pressure in ground water between grains of sand and silt. This turns sand into a viscous liquid ”quicksand”.
  60. 60. Tsunamis giant waves that travel at speeds of 700-800 km/hr and reach height of 20+meters
  61. 61. Earthquake hazard is a measurement of how likely an area is to have damaging quakes in the future. It’s determined by past and present seismic activity
  62. 62. Seismologists look for patterns in earthquake data to try and predict future earthquakes. The strength and frequency are important factors in the prediction of earthquakes. Major earthquake is more likely to occur along part of an active fault that have had few or no earthquakes happen in recent times. This is known as the…
  63. 63. Changes in the behavior of animals Changes in water level (lakes, streams, wells, etc.) These methods are not completely accurate and will only suggest that an earthquake may occur
  64. 64. • DROP down onto your hands and knees before the earthquake would knock you down. This position protects you from falling but still allows you to move if necessary. • COVER your head and neck (and your entire body if possible) under the shelter of a sturdy table or desk. If there is no shelter nearby, get down near an interior wall or next to low-lying furniture that won't fall on you, and cover your head and neck with your arms and hands. Try to stay clear of windows or glass that could shatter or objects that could fall on you. • HOLD ON to your shelter (or to your head and neck) until the shaking stops. Be prepared to move with your shelter if the shaking shifts it around.
  65. 65. 66
  66. 66. • If you are outside, stay outside, and stay away from buildings utility wires, sinkholes, and fuel and gas lines. • The area near the exterior walls of a building is the most dangerous place to be • Stay away from this danger zone--stay inside if you are inside and outside if you are outside.The greatest danger from falling debris is just outside doorways and close to outer walls 67
  67. 67. Establish Priorities • Take time before an earthquake strikes to write an emergency priority list, including: – important items to be hand-carried by you – other items, in order of importance to you and your family – items to be removed by car or truck if one is available – things to do if time permits, such as locking doors and windows, turning off the utilities, etc. 68
  68. 68. Write Down Important Information • Make a list of important information and put it in a secure location. Include on your list: • important telephone numbers, such as police, fire, paramedics, and medical centers • the names, addresses, and telephone numbers of your insurance agents, including policy types and numbers • important medical information, such as allergies, regular medications, etc.your bank's telephone number, account types, and numbers 69
  69. 69. Gather and Store Important Documents in a Fire-Proof Safe • Birth certificates • Ownership certificates (automobiles, boats, etc.) • Social Security cards • Insurance policies • Wills • Household inventory 70
  70. 70. FLOODS, FLASH FLOODS • Flash floods and floods are the #1 cause of deaths associated with thunderstorms...more than 140 fatalities each year. • Most flash flood fatalities occur at night and most victims are people who become trapped in automobiles. • Six inches of fast-moving water can knock you off your feet; a depth of two feet will cause most vehicles to float.
  71. 71. Hurricanes and Typhoons • Hurricane: tropical storms with winds of constant speed of >74 miles/hr • Atlantic: hurricane; Pacific: typhoons • Tropical depression, tropical storm: depends upon wind force- measured by Beaufort scale 72
  72. 72. Health Impact • • • • Drowning Electrocution Lacerations and punctures GI, respiratory, vector borne diseases and skin disease • Failure to evacuate, failure to follow guidelines on food and water safety: main causes of problems 73
  73. 73. Causes of Floods • Uncontrolled urbanization • Deforestation • Effects of El Nino 74
  74. 74. Flash Flood Safety Rules • Avoid walking, swimming, or driving in flood waters. • Stay away from high water, storm drains, ditches, ravines,. If it is moving swiftly, even water six inches deep can knock you off your feet. • Climb to higher ground • Do not let children play near storm drains.
  75. 75. Planning for Disaster Disaster Preparedness Isn’t Just a Case of Preparing for the Worst, it’s Being Prepared To Do Your Best When it Matters Most!
  76. 76. Preparation • Turn Off Utilities to Your Home. • Turn Off Gas, Water and Electricity • Turn Off the Water to Your Home. Advanced Preparation Can Save Precious Time! Prepare Kit in a Large, Watertight Container that can be moved easily (large plastic garbage can with wheels).
  77. 77. 72 Hour Emergency Kit (cont.) • 3 Day Supply of Non-Perishable Food Items (canned meats, fruits & vegetables) • 3 Day Supply of Water (1 gallon per person, per day) • Manual can opener, cooking supplies & utensils • Portable, Battery Operated Radio or TV (extra batteries) • Flashlight & Batteries • First Aid Kit & Large Trash Bags • Matches & Waterproof container • Whistle • Warm clothing & Rain Gear • Sanitation & Hygiene Items (Soap and Feminine Supplies) • Special Need Items for Children, Seniors or People w/Disabilities • Photocopies of Credit Cards and Identification (proof of address, DL, or Electric Bill) • Cash & Coins • Blanket or Sleeping Bags • Supplies for Pets All supplies should be checked every 6 months and out dated items replaced
  78. 78. Go Bag Items • • • • • • • • • • • Flashlight Portable Radio or TV Extra Batteries Whistle Dust mask Pocket Knife Emergency Cash & Coins in Small Denominations Sturdy Shoes, Change of Clothing and Warm Hat Water & Food First Aid Kit Permanent Marker, Paper and Tape • List of Emergency Phone Numbers • List of Allergies to Any Drug (especially antibiotics) • Copy of Health Insurance & Identification Cards • Extra Prescription Eye Glasses, Hearing Aid & Other Vital Items • Toothbrush & Toothpaste • Extra Keys to House & Vehicles • Special Need Items for Children, Seniors and People w/Disabilities • Photocopies of Credit Cards and Identification (proof of address, DL, or Electric Bill)
  79. 79. Health Impacts of Flooding • • • • Infectious disease Compromised personal hygiene Contamination of water sources Disruption of sewage service and solid waste collection • Increased vector borne diseases (leptospirosis, hepa A, E.coli, giardiasis) 80
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  84. 84. Epidemics • An outbreak or occurrence of one specific disease from a single source in a group or population in excess of the usual or expected • Exists when new cases exceed the prevalence of disease • Prevalence: number of people within a population who have a certain disease at a given point in time • Acute outbreak 85
  85. 85. Requirements for Epidemic • Susceptible population • Presence of disease agent • Large scale transmission (contaminated water or vector population) • Can lead to serious disability or death • Inability of authorities to cope adequately 86
  86. 86. 87
  87. 87. • SARS: Severe Acute Respiratory Syndrome • Viral (coronavirus) • O2, anti-pyretics, ventilatory support • Influenza A (H1N1) virus is a subtype of influenza A virus and was the most common cause of human influenza (flu) • Some strains of H1N1 are endemic in humans and cause a small fraction of all influenza-like illness and a small fraction of all seasonal influenza • Other strains of H1N1 are endemic in pigs (swine influenza) and in birds (avian influenza) 88
  88. 88. • • • • • MERS-COV viral respiratory illness a beta coronavirus. It was first reported in 2012 in Saudi Arabia not the same coronavirus that caused severe acute respiratory syndrome (SARS) • people who got infected developed severe acute respiratory illness with symptoms of fever, cough, and shortness of breath 89
  89. 89. Countries France Italy Jordan Qatar Saudi Arabia Tunisia United Kingdom (UK) United Arab Emirates (UAE) Total Cases (Deaths) 2 (1) 3 (0) 2 (2) 2 (1) 71 (39) 2 (0) 3 (2) 6 (1) 91 (46) 90
  90. 90. Notice Level Level 1: Watch Traveler Action Risk to Traveler Usual baseline risk or slightly Reminder to above baseline follow usual risk for precautions destination for this and limited destination impact to the traveler Outbreak/Event Example Dengue in Panama-Outbreak Watch: Because dengue is endemic to Panama, this notice most likely would signify that there is a slightly higher rate of dengue cases than predicted. Travelers are to follow “usual” insect precautions. Olympics in London-Event Watch: There may be possible health conditions in London that could impact travelers during the Olympics, such as measles. Travelers are to follow usual health precautions making sure they are up to date on their measles vaccine, follow traffic safety laws and use sunscreen 91
  91. 91. Increased risk in defined Follow settings enhanced Level 2: or precaution Alert associate s for this d with destination specific risk factors Yellow Fever in Brazil-Outbreak Alert: Because an outbreak of yellow fever was found in areas of Brazil outside of the reported yellow fever risk areas, this would be a change in “usual” precautions. Travelers should follow “enhanced precautions” for that risk area by receiving the yellow fever vaccine. Flooding in El Salvador-Event Alert: There are possible conditions that could affect the health of the traveler and parts of the destination’s infrastructure could be compromised. Travelers are to follow special precautions for flooding 92
  92. 92. SARS in Asia-Outbreak Warning: Because SARS spread quickly and had a high case fatality rate, a warning notice signifies there was a Avoid all high chance a traveler could be nonHigh risk infected. Travelers should not Level 3: essential to travel if possible. Warning travel to travelers this Earthquake in Haiti-Event destination Warning: The destination’s infrastructure (sanitation, transportation, etc.) cannot support travelers at this time. 93
  93. 93. MULTI-DRUG RESISTANT ORGANISMS • Prevention of antimicrobial resistance depends on appropriate clinical practices that should be incorporated into all routine patient care • As per CDC guidelines 94
  94. 94. MEASURES IN THE HOSPITAL INCLUDES • optimal management of vascular and urinary catheters • prevention of lower respiratory tract infection in intubated patients • accurate diagnosis of infectious etiologies • judicious antimicrobial selection and utilization 95
  95. 95. Infection Control Precautions. • Standard Precautions – Hand hygiene is an important component of Standard Precautions. • Contact Precautions – prevent transmission of infectious agents which are transmitted by direct or indirect contact with the patient or the patient's environment 96
  96. 96. Contact Precautions • A single-patient room is preferred for patients who require Contact Precautions. • When a single-patient room is not available, consultation with infection control is necessary to assess the various risks associated with other patient placement options (e.g., cohorting, keeping the patient with an existing roommate) 97
  97. 97. • HCP caring for patients on Contact Precautions should wear a gown and gloves for all interactions that may involve contact with the patient or potentially contaminated areas in the patient's environment. • Donning gown and gloves upon room entry and discarding before exiting the patient room is done to contain pathogens, especially those that have been implicated in transmission through environmental contamination 98
  98. 98. • discontinue Contact Precautions when three or more surveillance cultures for the target MDRO are repeatedly negative over the course of a week or two in a patient who has not received antimicrobial therapy for several weeks, especially in the absence of a draining wound, profuse respiratory secretions, or evidence implicating the specific patient in ongoing transmission of the MDRO within the facility. 99
  99. 99. • Some bacteria present in an individual as a colony or flora in the body, without producing disease, which has a potential to spread • Decolonization – entails treatment of persons/Health Care Personnels (HCP) colonized with a specific MDRO, usually MRSA, to eradicate carriage of that organism – possible with several regimens that include topical mupirocin alone or in combination with orally administered antibiotics plus the use of an antimicrobial soap for bathing 100
  100. 100. • HCP implicated in transmission of MRSA are candidates for decolonization and should be treated and culture negative before returning to direct patient care. • In contrast, HCP who are colonized with MRSA, but are asymptomatic, and have not been linked epidemiologically to transmission, do not require decolonization. 101
  101. 101. Resistant Microorganisms • MRSA: – Methicillin resistant Staphylococcus Aureus – Vancomycin is the treatment of choice – Necessary to do a nasal swab to detect presence in persons at risk – Treated accordingly with Vancomycin in infected individuals – Decolonize persons withtopical mupirocin alone or in combination with orally administered antibiotics plus the use of an antimicrobial soap for bathing 102
  102. 102. VRE: Vancomycin Resistant Enterococcus • In some instances, enterococci have become resistant to vancomycin • These bacteria are normally present in the human intestines and in the female genital tract and are often found in the environment 103
  103. 103. RISK FACTORS • People who have been previously treated with the antibiotic vancomycin or other antibiotics for long periods of time. • People who are hospitalized, particularly when they receive antibiotic treatment for long periods of time. • People with weakened immune systems such as patients in intensive care units, or in cancer or transplant wards. • People who have undergone surgical procedures such as abdominal or chest surgery. • People with medical devices that stay in for some time such as urinary catheters or central intravenous (IV) catheters. • People who are colonized with VRE 104
  104. 104. MANAGEMENT • People with colonized VRE (bacteria are present, but have no symptoms of an infection) do not need treatment. • Most VRE infections can be treated with antibiotics other than vancomycin. – IMPORTANT TO HAVE SENSITIVITY TEST 1ST! • For people who get VRE infections in their bladder and have urinary catheters, removal of the catheter when it is no longer needed can also help get rid of the infection. 105
  105. 105. Brukholderia cepacia • Can be present in the environment even in betadine solutions, mouthwashes, and soil • Causes severe pneumonia in susceptible patients • Treated with a wide range of antibiotics as long as it is sensitive to it 106
  106. 106. Clostridium difficle • a form of a Hospital acquired infection • clinical manifestations of infection with toxin-producing strains of C. difficile • range from symptomless carriage, to mild • or moderate diarrhea, to fulminant and sometimes fatal pseu-domembranous colitis. 107
  107. 107. RISK FACTORS • commonly seen in older adults, who take antibiotics and also get medical care. 108
  108. 108. TREATMENT • Vancomycin as 1st line drug 109
  109. 109. • Klebsiella: type of gram-negative bacteria that can cause infections in healthcare settings, including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis. • Klebsiella bacteria have developed antibiotic resistance, most recently to the class of antibiotics known as carbapenems. • When bacteria such as Klebsiella pneumoniae produce an enzyme known as a carbapenemase, they are referred to as KPC producing organisms or carbapenem-resistant Klebsiella pneumoniae (CRKP) 110
  110. 110. BETA-LACTAMASE PRODUCING BACTERIA • Metallo-beta-lactamase-1 (NDM-1) – Commonly gram negative – makes bacteria resistant to a broad range of beta-lactam antibiotics – These include the antibiotics of the carbapenem family, which are a mainstay for the treatment of antibiotic-resistant bacterial infections 111
  111. 111. Metallo-beta-lactamase-1 (NDM-1) • resistant to multiple different classes of antibiotics, including beta-lactam antibiotics, fluoroquinolones, and aminoglycosides • most were still susceptible to the polymyxin antibiotic COLISTIN. 112
  112. 112. Extended-spectrum betalactamase (ESBL) • confer resistance to penicillins • Also are resistant to extended-spectrum cephalosporins including cefotaxime, ceftriaxone, and ceftazidime and aztreonam • Once an ESBL-producing strain is detected, the laboratory should report it as "resistant" to all penicillins, cephalosporins, and aztreonam, even if it is tested (in vitro) as susceptible 113
  113. 113. Extended-spectrum betalactamase (ESBL) • Currently, carbapenems are, in general, regarded as the preferred agent for treatment of infections due to ESBLproducing organisms 114