{"id":10267,"date":"2025-03-01T14:03:21","date_gmt":"2025-03-01T19:03:21","guid":{"rendered":"https:\/\/www-test.dhss.delaware.gov\/dph\/dhan297\/"},"modified":"2025-03-02T00:51:24","modified_gmt":"2025-03-02T05:51:24","slug":"dhan297","status":"publish","type":"page","link":"https:\/\/www-test.dhss.delaware.gov\/dph\/php\/alerts\/dhan297\/","title":{"rendered":"php\/alerts\/dhan297 ~  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\/dhan297.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\"]-->297 <!--[END]--> <\/h1>\n\n      <h2> <!--[type=EDIT name=\"DHAN Date\"]-->February 20, 2013 10:48 am <!--[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; Programs<\/a><\/li>\n        <li><a href=\"\/dph\/ofclocations.html\">Office Locations<\/a><\/li>\n        <li><a href=\"\/dph\/contact.html\">Contact Info<\/a><\/li>\n      \n        <li><a href=\"\/calendars.html\" target=\"_blank\">Calendar<\/a><\/li>\n      <\/ul>\n    <\/li>\n    <li class=\"toplevel\"><a data-parent=\"#sidebar\" data-toggle=\"collapse\" href=\"#ServicesMenu\"><h2>Services <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"ServicesMenu\">\n        <li><a href=\"\/dph\/servicesaz.html\">A-Z Services<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/environmental.html\">Air &#038; Water Quality<\/a><\/li>\n        <li><a href=\"\/dph\/ss\/vitalstats.html\">Birth, Death, &#038; Marriage Records<\/a><\/li>\n        <li><a href=\"\/dph\/clinics.html\">Clinics<\/a><\/li>\n        <li><a href=\"\/dph\/healthdatastats.html\">Health Data &#038; Statistics<\/a><\/li>\n        <li><a href=\"\/dph\/php\/emsps.html\">Emergency Preparedness<\/a><\/li>\n        <li><a href=\"\/dph\/healthandwellness.html\">Health &#038; Wellness<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/healthyhomes.html\">Healthy Homes<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/healthywp.html\">Healthy Workplaces<\/a><\/li>\n        <li><a href=\"\/dph\/lab\/labs.html\">Laboratory<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/feir.html\">Restaurant Inspections<\/a><\/li>\n        <li><a href=\"\/dph\/screen.html\">Screening and Testing<\/a><\/li>\n        <li><a href=\"\/dph\/chca\/dphwichominf01.html\">WIC<\/a><\/li>\n        <li><a href=\"\/dph\/servicesadd.html\">Additional Services<\/a><\/li><li>\n      <\/li><\/ul>\n    <\/li>\n    <li class=\"toplevel\"><a data-parent=\"#sidebar\" data-toggle=\"collapse\" href=\"#InformationMenu\"><h2>Information <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n        <ul class=\"panel-collapse collapse\" id=\"InformationMenu\">\n        <li><a href=\"\/dph\/factsheetsaz.html\">A-Z Fact Sheets<\/a><\/li>\n        <li><a href=\"\/dph\/pubreportsaz.html\">A-Z Publications &#038; Reports<\/a><\/li>\n        <li><a href=\"\/dph\/diseasesandconditions.html\">Diseases &#038; Conditions<\/a><\/li>\n        <li><a href=\"\/dph\/faq.html\">FAQ&#8217;s<\/a><\/li>\n        <li><a href=\"\/dph\/php\/alerts.html\">Health Alerts<\/a><\/li>\n        <li><a href=\"\/dph\/healthylifestyles.html\">Healthy Lifestyles<\/a><\/li>\n        <li><a href=\"\/dph\/hipaa.html\">HIPAA<\/a><\/li>\n        <li><a href=\"\/dph\/regs.html\">Regulations<\/a><\/li>\n        <li><a href=\"\/dph\/forms.html\">Request Forms<\/a><\/li>\n        <li><a href=\"\/dph\/links.html\">Links &#038; Resources<\/a><\/li>\n        <li><a href=\"http:\/\/delaware.gov\/help\/foia_request.shtml\">FOIA Request Form<\/a><\/li>\n      <\/ul>\n    <\/li>\n    <li><a id=\"SocialMenuHeader\"><h2>Connect <i class=\"fa fa-thumbs-o-up fa-fw\"><\/i><\/h2><\/a>\n      <ul id=\"SocialMenu\">\n        <li class=\"facebook\"><a href=\"https:\/\/www.facebook.com\/DEPublicHealth\" target=\"_blank\" title=\"Division of Public Health Facebook Page\"><i class=\"fa fa-facebook-square fa-lg\"><\/i> Facebook<\/a><\/li>\n        <li class=\"twitter\"><a href=\"https:\/\/twitter.com\/Delaware_DHSS\" target=\"_blank\" title=\"Delaware Health and Social Services Twitter Account\"><i class=\"fa fa-twitter-square fa-lg\"><\/i> Twitter<\/a><\/li>\n        <!-- <li class=\"googleplus\"><a href=\"#\"><i class=\"fa fa-google-plus-square fa-lg\"><\/i> Google +<\/a><\/li>\n        <li class=\"flickr\"><a href=\"#\"><i class=\"fa fa-flickr fa-lg\"><\/i> Flickr<\/a><\/li>\n        <li class=\"youtube\"><a href=\"#\"><i class=\"fa fa-youtube-square fa-lg\"><\/i> Youtube<\/a><\/li>\n        <li class=\"instagram\"><a href=\"#\"><i class=\"fa fa-instagram fa-lg\"><\/i> Instagram<\/a><\/li>\n        <li class=\"linkedin\"><a href=\"#\"><i class=\"fa fa-linkedin-square fa-lg\"><\/i> Linkedin<\/a><\/li>\n        <li class=\"pinterest\"><a href=\"#\"><i class=\"fa fa-pinterest-square fa-lg\"><\/i> Pinterest<\/a><\/li> -->\n      <\/ul>\n    <\/li>\n  <\/ul>\n\n              <\/div>\n\n            <\/div>\n\n          <\/div>\n\n        <\/div><br>\n\n      <\/div>\n\n\n\n      <div class=\"col-md-9\" id=\"main_content\"> \n\n  \n\n<h2 class=\"center\">Health\n\n<!--[type=EDIT name=\"DHANType\"]-->\n\n\n\n   Advisory<!--[END]-->\n\n<br>\n\n<!--[type=EDIT name=\"DHAN Heading\"]-->\n\n\n\nCDC REPORTS NEW CARBAPENEM-RESISTANT ENTEROBACTERIACEAE (CRE) WARRANT ADDITIONAL ACTION BY\n\n\n  HEALTHCARE PROVIDERS<!--[END]-->\n\n<\/h2>\n\n\n\n<!--[type=HTMLEDIT name=\"Content\"]-->\n\n\n\n<p>\n\n\n  The Delaware Division of Public Health (DPH) is issuing this health advisory to provide the healthcare community with information from\n\n\n  the Centers for Disease Control and Prevention (CDC) on new Carbapenem-resistant Enterobacteriaceae (CRE) and the need for additional\n\n\n  steps to prevent the emergence and spread of these organisms. The CDC HAN can be found at <a href=\"http:\/\/emergency.cdc.gov\/HAN\/han00341.asp\">http:\/\/emergency.cdc.gov\/HAN\/han00341.asp<\/a>.\n\n\n<\/p>\n\n\n<h3>\n\n\n  Summary\n\n\n<\/h3>\n\n\n<p>\n\n\n  Carbapenem-resistant Enterobacteriaceae (CRE) are untreatable or difficult-to-treat multidrug-resistant organisms (MDROs) that are\n\n\n  emerging in the United States. Increasing reports of these MDROs has led CDC to alert healthcare providers to act aggressively to prevent\n\n\n  the emergence and spread of unusual CRE organisms. Although still uncommon, of 37 unusual forms of CRE that have been reported in the\n\n\n  United States, the last 15 have been reported since July 2012. Because the vast majority of these unusual organisms were isolated from\n\n\n  patients who received overnight medical treatment outside of the United States, additional measures described in this advisory are now\n\n\n  recommended for use when such patients are hospitalized in the United States.\n\n\n<\/p>\n\n\n<h3>\n\n\n  Background\n\n\n<\/h3>\n\n\n<p>\n\n\n  <em>Klebsiella<\/em> species and <em>Escherichia coli<\/em> are examples of Enterobacteriaceae, a family of bacteria that normally live in\n\n\n  water, soil, and the human gut. CRE are Enterobacteriaceae that have developed high levels of resistance to antibiotics, including\n\n\n  last-resort antibiotics called carbapenems. CRE infections most commonly occur among patients who are receiving antibiotics and\n\n\n  significant medical treatment for other conditions.\n\n\n<\/p>\n\n\n<p>\n\n\n  Most CRE in the United States produce a carbapenemase called <em>Klebisella pneumoniae<\/em> carbapenemase, or KPC. Unusual forms of CRE\n\n\n  such as those with the New Delhi Metallo-\u03b2-lactamase (NDM) and Verona Integron-mediated Metallo-\u03b2-lactamase (VIM) have been\n\n\n  very uncommon in the United States but are more common in other parts of the world.\n\n\n<\/p>\n\n\n<p>\n\n\n  Many countries do not actively look for CRE therefore, it is unclear which countries have experienced unusual carbapenemases (e.g., NDM,\n\n\n  VIM) and it is difficult to know their overall incidence at any given time. However, the vast majority of CRE reported to CDC were\n\n\n  isolated from patients with a history of an overnight stay in a healthcare facility outside the United States.\n\n\n<\/p>\n\n\n<h4>\n\n\n  Infection Control Recommendations\n\n\n<\/h4>\n\n\n<ol>\n\n\n  <li>CDC continues to recommend that facilities follow the CDC guidance for preventing the spread of CRE in healthcare settings:\n\n\n    <a href=\"http:\/\/www.cdc.gov\/hai\/organisms\/cre\/cre-toolkit\/index.html\">http:\/\/www.cdc.gov\/hai\/organisms\/cre\/cre-toolkit\/index.html<\/a>.\n\n\n  <\/li>\n\n\n  <li>CDC now also recommends the following:\n\n\n    <ol class=\"lower-alpha\">\n\n\n      <li>When a CRE is identified in a patient (infection or colonization) with a history of an overnight stay in a healthcare facility\n\n\n      (within the last 6 months) outside the United States, send the isolate to a reference laboratory for confirmatory susceptibility\n\n\n      testing and tests to determine the carbapenem resistance mechanism; at a minimum, this should include evaluation for KPC and NDM\n\n\n      carbapenemases.\n\n\n      <\/li>\n\n\n      <li>For patients admitted to healthcare facilities in the United States after recently being hospitalized (within the last 6 months)\n\n\n      in countries outside the United States, consider each of the following:\n\n\n        <ol class=\":decimal\">\n\n\n          <li>Perform rectal screening cultures to detect CRE colonization.\n\n\n          <\/li>\n\n\n          <li>Place patients on <a class=\"anchors_link\" href=\"http:\/\/www.cdc.gov\/hai\/organisms\/cre\/cre-toolkit\/f-level-prevention.html#facility-measures\">Contact Precautions<\/a> (including use of gloves and gowns for any contact with patient) while awaiting\n\n\n            the results of these screening cultures.\n\n\n          <\/li>\n\n\n        <\/ol>\n\n\n      <\/li>\n\n\n    <\/ol>\n\n\n  <\/li>\n\n\n<\/ol>\n\n\n<h4>\n\n\n  Additional Information\n\n\n<\/h4>\n\n\n<ul>\n\n\n  <li>CDC HAN: <a href=\"http:\/\/emergency.cdc.gov\/HAN\/han00341.asp\">http:\/\/emergency.cdc.gov\/HAN\/han00341.asp<\/a>\n\n\n  <\/li>\n\n\n  <li>CDC guidance for preventing the spread of CRE in healthcare settings: <a href=\"http:\/\/www.cdc.gov\/hai\/organisms\/cre\/cre-toolkit\/index.html\">http:\/\/www.cdc.gov\/hai\/organisms\/cre\/cre-toolkit\/index.html<\/a>\n\n\n  <\/li>\n\n\n  <li>A laboratory-based screening protocol is available at (<a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/Klebsiella_or_Ecoli.pdf\">http:\/\/www.cdc.gov\/HAI\/pdfs\/labSettings\/Klebsiella_or_Ecoli.pdf<\/a>)\n\n\n  <\/li>\n\n\n  <li>Patient facility transfer forms are available at <a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/InterfacilityTransferCommunicationForm11-2010.pdf\">http:\/\/www.cdc.gov\/HAI\/toolkits\/InterfacilityTransferCommunicationForm11-2010.pdf<\/a>\n\n\n  <\/li>\n\n\n  <li>CDC\u2019s <a href=\"http:\/\/www.cdc.gov\/hai\/organisms\/cre\/cre-toolkit\/index.html\">CRE toolkit<\/a> (<a href=\"http:\/\/www.cdc.gov\/hai\/organisms\/cre\/cre-toolkit\/index.html\">http:\/\/www.cdc.gov\/hai\/organisms\/cre\/cre-toolkit\/index.html<\/a>\n\n\n  <\/li>\n\n\n  <li>Delaware Division of Public Health, Bureau of Epidemiology (24\/7): 1-888-295-5156\n\n\n  <\/li>\n\n\n<\/ul><br>\n\n\n<br>\n\n\n<p class=\"smalltext\"><a href=\"http:\/\/www.adobe.com\/products\/acrobat\/readstep2.html\"><img loading=\"lazy\" decoding=\"async\" alt=\"Download Adobe Acrobat Reader\" height=\"21\" src=\"\/wp-content\/uploads\/dhss\/img\/getacro60.gif\" width=\"60\"><\/a> Please note: Some of the files available on this page are in Adobe PDF format which requires Adobe Acrobat Reader.  A free copy of Adobe Acrobat Reader can be downloaded directly from <a href=\"http:\/\/www.adobe.com\/products\/acrobat\/readstep2.html\">Adobe <\/a>. If you are using an assistive technology unable to read Adobe PDF, please either view the corresponding text only version (if available) or visit Adobe&#8217;s <a href=\"http:\/\/access.adobe.com\">Accessibility Tools page<\/a>.<\/p>\n\n\n\n<p>\n\n\n  ******************\n\n\n<\/p>\n\n\n<p>\n\n\n  You are receiving this message because you are a registered member of the Delaware Health Alert Network. If you are not a member and\n\n\n  would 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 #297 February 20, 2013 10:48 am 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-10267","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10267","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/comments?post=10267"}],"version-history":[{"count":1,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10267\/revisions"}],"predecessor-version":[{"id":11443,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10267\/revisions\/11443"}],"up":[{"embeddable":true,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9294"}],"wp:attachment":[{"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/media?parent=10267"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}