This document provides information on various agents that could potentially be used for terrorism purposes, including diseases, chemicals, and radiation. It discusses specific diseases like anthrax, smallpox, botulism, plague, and hemorrhagic fever, describing their symptoms and treatments. It also covers chemical agents like sarin, phosgene, and mustard gas, as well as the effects of ionizing radiation. The document concludes by addressing blast injuries from explosions and outlining emergency procedures for evaluation, management, and evacuation in the event of a terrorist attack.

1. Agents of Terrorism

2. Terrorism
• Dispensing of disease pathogens
(bioterrorism) or other agents (chemical,
nuclear, radioactive, explosive devices) to
express harm
2

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. 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. 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

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. Plague
•
•
•
•
Bacteria found in rodents and fleas
Bubonic, pneumonic, septicemic
Hemotypsis, cough, high fever, resp failure
Tx: ATB (aminoglycosides)
8

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. 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. 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

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. 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. • Secondary: Injury from projectiles (bomb
fragments, flying debris) — Penetrating
trauma, fragmentation injuries, blunt trauma
15

16. • • Tertiary: Injuries from displacement of
victim by the blast wind —
Blunt/penetrating trauma, fractures, and
traumatic amputations
16

17. • Quaternary: All other injuries from the blast
— Crush injuries, burns, asphyxia, toxic
exposures, exacerbations of chronic illness
17

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. 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. • 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. • 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. • 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. 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. • 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

25. FIRE PREPAREDNESS
25

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Common Causes of Fires in
Health Care Facilities
•
•
•
•
•
•
•
Electrical Malfunctions
Friction
Open Flames
Sparks
Hot Surfaces
Compressed O2
Anesthetic Gases
37

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. 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. 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. 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. Classification of Fires & Extinguishers
Class A Fires
Wood
Paper
Rags
Some
rubber
and plastic
materials
42

43. Classification of Fires & Extinguishers
Class B Fires
 Gasoline
 Oil
 Grease
 Paint
 Flammable Gases
 Some
rubber and
plastic materials
43

44. Classification of Fires & Extinguishers
Class C Fires

Electrical Fires
– Office Equipment
– Motors
– Switchgear
– Heaters
44

45. Classification of Fires & Extinguishers
Class D Fires
Metals
– Magnesium
– Titanium
– Sodium
– Zirconium
– Potassium
– Lithium
45

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. Different Kinds of Extinguishers
–All Purpose Water
–Carbon Dioxide
–Multi-Purpose Dry
Chemical
–Dry Powder
Water
Carbon Dioxide
47

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. Fire Extinguishers
Inspection, Maintenance and Testing
• Visually inspected monthly
• Maintained annually
• Hydrostatically tested
periodically (5 or 12 yrs.)
49

50. Partnership with Red Cross
• Pre-fire planning
• Campus building surveys
• Training / Education
50

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

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. 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 : http://www.thetech.org/exhibits/online/quakes/seismo/

56. Written record of earthquake waves
Used to determine epicenter and
when earthquakes occurred
Shows magnitude (strength) of waves
with height of lines

57. Epicenter: surface origin of
seismic waves (surface
waves) directly above focus
Focus:
underground point
of origin for
earthquake body
waves

58. Why do you need
3
stations reporting the
same earthquake data?
Triangulation results in one epicenter location.

59. •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

60. Liquefaction
Vibrations cause pressure in ground water
between grains of sand and silt. This turns
sand into a viscous liquid ”quicksand”.

61. Tsunamis
giant waves that travel at speeds of
700-800 km/hr and reach height of
20+meters

62. 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

63. 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…

64. 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

65. • 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.

66. 66

67. • 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

68. 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

69. 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

70. 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

71. 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.

72. 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

73. 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

74. Causes of Floods
• Uncontrolled urbanization
• Deforestation
• Effects of El Nino
74

75. 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.

76. 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!

77. 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).

78. 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

79. 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)

80. 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

81. 81

82. 82

83. 83

84. 84

85. 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

86. 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

87. 87

88. • 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

89. •
•
•
•
•
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

90. 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

91. 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

92. 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

93. 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

94. 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

95. 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

96. 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

97. 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

98. • 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

99. • 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

100. • 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

101. • 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

102. 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

103. 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

104. 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

105. 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

106. 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

107. 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

108. RISK FACTORS
• commonly seen in older adults, who take
antibiotics and also get medical care.
108

109. TREATMENT
• Vancomycin as 1st line drug
109

110. • 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

111. 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

112. 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

113. 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

114. Extended-spectrum betalactamase (ESBL)
• Currently, carbapenems are, in general,
regarded as the preferred agent for
treatment of infections due to ESBLproducing organisms
114