1. . Nosocomial Antibiotic Resistant Organisms Copyright © Texas Education Agency, 2014. All rights reserved.

2. . Copyright © Texas Education Agency, 2014. These Materials are copyrighted © and trademarked ™ as the property of the Texas Education Agency (TEA) and may not be reproduced without the express written permission of TEA, except under the following conditions: 1) Texas public school districts, charter schools, and Education Service Centers may reproduce and use copies of the Materials and Related Materials for the districts’ and schools’ educational use without obtaining permission from TEA. 2) Residents of the state of Texas may reproduce and use copies of the Materials and Related Materials for individual personal use only, without obtaining written permission of TEA. 3) Any portion reproduced must be reproduced in its entirety and remain unedited, unaltered and unchanged in any way. 4) No monetary charge can be made for the reproduced materials or any document containing them; however, a reasonable charge to cover only the cost of reproduction and distribution may be charged. Private entities or persons located in Texas that are not Texas public school districts, Texas Education Service Centers, or Texas charter schools or any entity, whether public or private, educational or non-educational, located outside the state of Texas MUST obtain written approval from TEA and will be required to enter into a license agreement that may involve the payment of a licensing fee or a royalty. For information contact: Office of Copyrights, Trademarks, License Agreements, and Royalties, Texas Education Agency, 1701 N. Congress Ave., Austin, TX 78701-1494; phone 512-463-7004; email: copyrights@tea.state.tx.us.copyrights@tea.state.tx.us Copyright © Texas Education Agency, 2014. All rights reserved.

3. . How Antibiotic Resistance Happens There are many bacteria and a few of them are drug resistant, naturally. Patient is given antibiotics that kill the infecting bacteria that is not resistant as well as the ‘good’ bacteria in the gut that help protect the body from infection. The drug resistant bacteria are now allowed to grow and take over. Some of the drug resistant bacteria share their resistance with other bacteria causing more problems. Copyright © Texas Education Agency, 2014. All rights reserved.

4. . Examples of How Antibiotic Resistance Spreads Animals get antibiotics and develop resistant organisms in their gut. Humans get prescribed antibiotics and develop resistant organisms in their gut. Drug resistant bacteria from animals can spread to crops through using manure as fertilizer or when cuts of meat are not cooked or handled properly. Humans can spread resistant bacteria in the community they are in or get treatment in a health care facility like a nursing home or hospital and spread the resistant organisms there. Once in a health care facility resistant organisms are spread through fomites or inanimate objects or by health care workers going between patients. Copyright © Texas Education Agency, 2014. All rights reserved.

5. . Methicillin-resistant Staphylococcus aureus (MRSA) is becoming more prevalent in healthcare settings. MRSA is a type of staph bacteria that is resistant to certain antibiotics called beta- lactams. These antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin, and amoxicillin. According to CDC data, the proportion of infections that are antimicrobial resistant has been growing. In 1974, MRSA infections accounted for two percent of the total number of staph infections; in 1995 it was 22%; in 2004 it was 63%. Copyright © Texas Education Agency, 2014. All rights reserved.

6. . MRSA - Methicillin resistant Staphylococcus aureus Resistant to most antibiotics Found in health care facilities – hospitals – long term care facilities – other care facilities Not a threat to a healthy individual Copyright © Texas Education Agency, 2014. All rights reserved.

7. . MRSA Concerns MRSA is difficult to contain MRSA is easily spread Copyright © Texas Education Agency, 2014. All rights reserved.

8. . MRSA Risk Factors Surgery Devices used in invasive procedures Burn wards or intensive care units (ICU) Age Treatment with multiple antibiotics Severe illness or disability Prolonged or repeated hospital stays Compromised immune system Copyright © Texas Education Agency, 2014. All rights reserved.

9. . MRSA Transmission Direct contact between health-care workers and clients. Health-care workers are the main carriers of MRSA Colonization vs. Infection – Colonization means that the organism is present or in the body, but is not causing illness. – Infection means that the organism is present and causing illness. MRSA is not usually spread through the air Copyright © Texas Education Agency, 2014. All rights reserved.

10. . Identifying MRSA infection Symptoms – Drainage from a wound – Fever and chills – Elevated white blood count Common sites of infection – Respiratory tract – Surgical wounds – Perineum or rectum – Skin – Urinary tract Copyright © Texas Education Agency, 2014. All rights reserved.

11. . MRSA Prevention Proper hand-washing – Before caring for each patient – After removing gloves – Before leaving the patient’s room Follow facility protocol for standard precautions Copyright © Texas Education Agency, 2014. All rights reserved.

12. . Community Acquired MRSA MRSA infections that are acquired by persons who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are known as CA-MRSA infections. Staph or MRSA infections in the community are usually manifested as skin infections, such as pimples and boils, and occur in otherwise healthy people. Copyright © Texas Education Agency, 2014. All rights reserved.

13. . Vancomycin resistant enterococcus (VRE) – The majority of VRE infections occur in the hospital setting. Enterococci are bacteria that are normally present in the human intestines and in the female genital tract and are found in the environment. Vancomycin is an antibiotic used to treat infections caused by enterococci. In some instances, enterococci have become resistant to this drug and thus are called vancomycin- resistant enterococci (VRE). Copyright © Texas Education Agency, 2014. All rights reserved.

14. . VRE Concerns VRE is hard to treat VRE can pass on their drug-resistant genes Copyright © Texas Education Agency, 2014. All rights reserved.

15. . VRE Risk Factors Severe illness Treatment with multiple antibiotics Abdominal or cardiac surgery Devices used in invasive procedures Age Intensive care unit (ICU) Prolonged or repeated hospital stays Compromised immune system Copyright © Texas Education Agency, 2014. All rights reserved.

16. . Pathogenesis of VRE Opportunistic Bacteria transmitted between clients and health-care workers Colonized vs. infected persons Copyright © Texas Education Agency, 2014. All rights reserved.

17. . Signs of Infection Drainage from a wound Fever and chills Elevated white blood count Copyright © Texas Education Agency, 2014. All rights reserved.

18. . Role of health care workers in prevention of VRE Hand-washing helps stop the spread of VRE – Wash before caring for a patient – After removing gloves – Before leaving the patient’s room Follow facility protocol for standard precautions Copyright © Texas Education Agency, 2014. All rights reserved.

19. . Gram-negative bacteria are those bacteria that do not retain crystal violet dye in the Gram staining protocol. Copyright © Texas Education Agency, 2014. All rights reserved.

20. . Gram-negative Infections Include those caused by Klebsiella, Acinetobacter, Pseudomonas aeruginosa, and E. coli, as well as many other less common bacteria.. – Klebsiella bacteria are normally found in the human intestines and in human stool. Patients whose care requires devices like ventilators or intravenous catheters, and those taking long courses of certain antibiotics are most at risk for Klebsiella infections. – Acinetobacter is a group of bacteria commonly found in soil and water. Acinetobacter can also be found on the skin of healthy people, especially healthcare personnel. – Serious Pseudomonas infections usually occur in people in the hospital, especially those with weakened immune systems, those on breathing machines, those with devices such as catheters, and those with wounds from surgery or burns. Copyright © Texas Education Agency, 2014. All rights reserved.

21. . Gram-negative Infections – Cause infections including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis in healthcare settings – One of the several unique characteristics of Gram- negative bacteria is the structure of the outer membrane. This outer membrane protects the bacteria from several antibiotics, dyes, and detergents which would normally damage the inner membrane or cell wall. Copyright © Texas Education Agency, 2014. All rights reserved.