{"id":10296,"date":"2025-03-01T14:07:32","date_gmt":"2025-03-01T19:07:32","guid":{"rendered":"https:\/\/dhss.delaware.gov\/dph\/dhan324\/"},"modified":"2025-03-02T00:52:22","modified_gmt":"2025-03-02T05:52:22","slug":"dhan324","status":"publish","type":"page","link":"https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan324\/","title":{"rendered":"php\/alerts\/dhan324 ~  Division of Public Health &#8212; Health Alert  &#8211; Delaware Health and Social Services &#8211; State of Delaware"},"content":{"rendered":"<div data-swiftype-index=\"true\">\n\n\n\n  <br>\n\n\n\n  <div class=\"container\" id=\"main_header\"> \n\n    <!-- BEGIN readspeaker div -->\n\n    <div class=\"rs_skip rsbtn rs_preserve\" id=\"readspeaker_button1\">\n\n      <a accesskey=\"L\" class=\"rsbtn_play\" href=\"https:\/\/app-na.readspeaker.com\/cgi-bin\/rsent?customerid=7262&#038;lang=en_us&#038;readid=main_content&#038;url=https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan324.html\" title=\"Listen to this page using ReadSpeaker\">\n\n        <span class=\"rsbtn_left rsimg rspart\"><span class=\"rsbtn_text\"><span>Listen<\/span><\/span><\/span>\n\n        <span class=\"rsbtn_right rsimg rsplay rspart\"><\/span>\n\n      <\/a>\n\n    <\/div>\n\n    <!-- END readspeaker div -->\n\n\n\n    \n\n    <header class=\"pull-left\">\n\n      <h1>Delaware Health Alert Network #<!--[type=EDIT name=\"DHAN Number\"]-->324 <!--[END]--> <\/h1>\n\n      <h2> <!--[type=EDIT name=\"DHAN Date\"]-->May 5, 2014 3:08 pm <!--[END]--> <\/h2>\n\n    <\/header>\n\n  <\/div><br>\n\n \n\n  <div class=\"container\">\n\n    <div class=\"row\">\n\n      <div class=\"col-md-3\" id=\"leftCol\">\n\n        <div class=\"panel-group\" id=\"accordion\">\n\n          <div class=\"panel sectionmenu_panel\">\n\n            <div class=\"panel-heading\">\n\n              <p class=\"panel-title\"><a class=\"agency_nav\" data-parent=\"#accordion\" data-toggle=\"collapse\" href=\"#collapseOne\"><strong><i class=\"fa fa-align-justify fa-fw\"><\/i> Public Health Menu<\/strong><\/a><\/p>\n\n            <\/div>\n\n\n\n            <div class=\"panel-collapse collapse in\" id=\"collapseOne\">\n\n              <div class=\"panel-body\" id=\"clf_nav\">\n\n                  <ul class=\"nav nav-stacked nav-pills-clf\" id=\"agency_sidebar\">\n    <li><a href=\"\/dph\/\"><h2>Home <i class=\"fa fa-home fa-fw\"><\/i><\/h2><\/a><\/li>\n    <li class=\"toplevel\"><a data-parent=\"#agency_sidebar\" data-toggle=\"collapse\" href=\"#HomeMenu\"><h2>About <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"HomeMenu\">\n        <li><a href=\"\/dph\/about.html\">About DPH<\/a><\/li>\n        <li><a href=\"\/dph\/sections.html\">Sections &#038; 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The\n\n\n  first US case was attributed to Delaware with a second in Pennsylvania. Previous cases were found in Europe.\n\n\n<\/p>\n\n\n<h3>\n\n\n  Background\n\n\n<\/h3>\n\n\n<p>\n\n\n  <em>Pseudomonas<\/em> bacteria are found widely in the environment; however healthy people in the community usually do not develop serious\n\n\n  <em>Pseudomonas<\/em> infections. Serious infections can occur in patients in the hospital and\/or those with weakened immune systems. In\n\n\n  healthcare settings, <em>P. aeruginosa<\/em> causes pneumonia, bloodstream infections, urinary tract infections, and surgical site\n\n\n  infections.\n\n\n<\/p>\n\n\n<p>\n\n\n  Individuals with prolonged hospital stays, certain medical conditions like extensive burns, cystic fibrosis, immunocompromising\n\n\n  conditions and those with medical devices such as ventilators and catheters are at highest risk for life-threatening pseudomonal\n\n\n  infections. In hospitals, which are where the most serious infections occur, <em>Pseudomonas<\/em> can be spread on the hands of\n\n\n  healthcare workers or by equipment that gets contaminated and is not properly cleaned. <em>P. aeruginosa<\/em> frequently forms a biofilm\n\n\n  (bacterial matrix\/plaque) on medical equipment, and colonizes tissues of long-stay patients.\n\n\n<\/p>\n\n\n<h3>\n\n\n  Current Situation\n\n\n<\/h3>\n\n\n<p>\n\n\n  The NDM (New Delhi Metallo-beta-lactamase) gene is an antibiotic resistance gene that confers resistance to carbapenems and other\n\n\n  \u03b2-lactam antibiotics. Bacteria that have this gene have also been found to be resistant to most other classes of antibiotics and are\n\n\n  very difficult to treat. NDM has been well described among Enterobacteriaceae, such as <em>Klebsiella<\/em> spp and <em>Escherichia\n\n\n  coli<\/em> (Carbapenem-resistant Enterobacteriaceae- CRE), isolated in the US and elsewhere in the past several years. According to the\n\n\n  CDC, there have been 103 NDM-producing Enterobacteriaceae reported to CDC since 2009.\n\n\n<\/p>\n\n\n<p>\n\n\n  The situation is different with <em>Pseudomonas<\/em>, however, as this case from DE represents the first time the NDM gene is reported in\n\n\n  a <em>Pseudomonas<\/em> isolate in the United States. To our knowledge, there have been only 4 cases of NDM-producing <em>Pseudomonas<\/em>\n\n\n  described in the literature. All 4 were isolated in Europe between 2010 and 2013.\n\n\n<\/p>\n\n\n<p>\n\n\n  The Delaware case is an 81-year-old from New Castle County and represents the first case of NDM in <em>Pseudomonas<\/em> in Delaware and\n\n\n  in the United States. This individual is currently receiving medical care in Pennsylvania after a hospital stay in Delaware. To our\n\n\n  knowledge, as of today, this is the only case of this infection in a Delaware resident. According to the CDC, a second case has recently\n\n\n  been identified in a Pennsylvania resident. Investigations in Delaware and Pennsylvania are ongoing to further characterize the\n\n\n  situation.\n\n\n<\/p>\n\n\n<h3>\n\n\n  Recommendations for Healthcare Providers and Facilities:\n\n\n<\/h3>\n\n\n<p>\n\n\n  Infection control measures for preventing spread of carbapenem-resistant <em>Pseudomonas<\/em> are similar to the strategies used for\n\n\n  controlling CRE. DPH recommends following CDC CRE guidelines below &#8211; <a href=\"http:\/\/www.cdc.gov\/hai\/organisms\/cre\/cre-clinicians.html\">http:\/\/www.cdc.gov\/hai\/organisms\/cre\/cre-clinicians.html<\/a>:\n\n\n<\/p>\n\n\n<ul>\n\n\n  <li>Know if patients with multidrug-resistant organisms like CRE or carbapenem-resistant <em>Pseudomonas<\/em> are hospitalized at your\n\n\n  facility, and stay aware of infection rates. Ask if a patient has received medical care somewhere else, including another country.\n\n\n  <\/li>\n\n\n  <li>Place patients currently or previously colonized or infected with CRE or carbapenem-resistant <em>Pseudomonas<\/em> on Contact\n\n\n  Precautions. Whenever possible, dedicate rooms, equipment, and staff to patients with CRE or carbapenem-resistant <em>Pseudomonas<\/em>.\n\n\n  <\/li>\n\n\n  <li>As part of Contact Precautions, wear a gown and gloves when caring for patients colonized or infected with these bacteria.\n\n\n  <\/li>\n\n\n  <li>Perform hand hygiene \u2013 use alcohol-based hand rub or wash hands with soap and water (if hands are visibly soiled) before and\n\n\n  after contact with patients or their environment.\n\n\n  <\/li>\n\n\n  <li>Alert the receiving facility when you transfer a patient with CRE or carbapenem-resistant <em>Pseudomonas<\/em>, and find out when a\n\n\n  patient with CRE or carbapenem-resistant <em>Pseudomonas<\/em> transfers into your facility.\n\n\n  <\/li>\n\n\n  <li>Make sure labs immediately alert clinical and infection prevention staff when CRE or carbapenem-resistant <em>Pseudomonas<\/em> are\n\n\n  identified.\n\n\n  <\/li>\n\n\n  <li>Prescribe and use antibiotics wisely.\n\n\n  <\/li>\n\n\n  <li>Discontinue devices like urinary catheters as soon as no longer necessary.\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<h3>\n\n\n  <br>\n\n\n  For further information:\n\n\n<\/h3>\n\n\n<ul>\n\n\n  <li p=\"\">CDC &#8211; Carbapenem-resistant Enterobacteriaceae (CRE) <a href=\"http:\/\/www.cdc.gov\/HAI\/organisms\/cre\/\">http:\/\/www.cdc.gov\/HAI\/organisms\/cre\/<\/a>\n\n\n  <\/li>\n\n\n  <li>Emergence of NDM-1 Metallo-\u03b2-Lactamase in <em>Pseudomonas aeruginosa<\/em> Clinical Isolates from Serbia <a href=\"http:\/\/aac.asm.org\/content\/55\/8\/3929.long\">http:\/\/aac.asm.org\/content\/55\/8\/3929.long<\/a>\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<p>\n\n\n  ************************************\n\n\n<\/p>\n\n\n<p>\n\n\n  You are receiving this email because you are a registered member of the Delaware Health Alert Network. If you are not a member and would\n\n\n  like to subscribe, please register at <a href=\"https:\/\/healthalertde.org\">https:\/\/healthalertde.org<\/a>\n\n\n<\/p><!--[END]-->\n\n  \n\n        <div class=\"panel panel-danger\">\n\n          <div class=\"panel-heading\">    \n\n      <h2>Categories of Health Alert messages:<\/h2>\n\n       <\/div>\n\n       <div class=\"panel-body\">\n\n      <ul>\n\n        <li><strong>Health Alert:<\/strong> Conveys the highest level of importance; warrants immediate action or attention.<\/li>\n\n        <li><strong>Health Advisory:<\/strong> Provides important information for a specific incident or situation; may not require immediate action.<\/li>\n\n        <li><strong>Health Update:<\/strong> Provides updated information regarding an incident or situation; unlikely to require immediate action.<\/li>\n\n            <\/ul>\n\n         <div><strong>NOTE: This page is for informational purposes only and dated material (e.g. temporary websites) may not be available.<\/strong><\/div>\n\n          <\/div> \n\n        <\/div><br>  \n\n\n\n      <\/div>\n\n    <\/div>\n\n  <\/div><!-- \/container -->\n\n  <\/div>","protected":false},"excerpt":{"rendered":"<p>Listen Delaware Health Alert Network #324 May 5, 2014 3:08 pm Public Health Menu Home About About DPH Sections &#038; Programs Office Locations Contact Info Calendar Services A-Z Services Air &#038; Water Quality Birth, Death, &#038; Marriage Records Clinics Health Data &#038; Statistics Emergency Preparedness Health &#038; Wellness Healthy Homes Healthy Workplaces Laboratory Restaurant Inspections [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":9294,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-10296","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10296","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/comments?post=10296"}],"version-history":[{"count":1,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10296\/revisions"}],"predecessor-version":[{"id":11472,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10296\/revisions\/11472"}],"up":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9294"}],"wp:attachment":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/media?parent=10296"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}