The Public Health Response to CRE in Wisconsin (Part 3 of a 3-part Series on the August 2015 Vital Signs: Making Health Care Safer: Stop Spread of Antibiotic Resistance)

Posted on by DHQP

The latest CDC Vital Signs includes mathematical modeling that projects increases in drug-resistant infections and Clostridium difficile (C. difficile) without immediate, nationwide improvements in infection control and antibiotic prescribing. During the next five years, with investments, CDC’s efforts to combat C. difficile infections and antibiotic resistance under the National Strategy to Combat Antibiotic Resistant Bacteria, in collaboration with other federal partners, will enhance national capabilities for antibiotic stewardship, outbreak surveillance, and antibiotic resistance prevention. The proposed State Antibiotic Resistance Prevention Programs (Protect Programs) would implement this coordinated approach.

While the coordinated approach this Vital Signs report describes is a forward-looking approach, some states are already implementing the response in a variety of different ways. This three-part blog series spotlights the current efforts in Tennessee, Illinois and Wisconsin.

Gwen Borlaug, CIC, MPH
Gwen Borlaug, CIC, MPH

Author: Gwen Borlaug, CIC, MPH, Coordinator, Healthcare-Associated Infections (HAI) Prevention Program, Division of Public Health, Wisconsin Department of Health Services

Some germs are beating even our strongest antibiotics. For example, Carbapenem-resistant Enterobacteriaceae (CRE) is a triple threat – it can be untreatable, cause death, and can give their antibiotic-fighting abilities to other germs.

CDC urges health departments to know antibiotic-resistant threats in the area and state, such as CRE germs in healthcare facilities, to assist in the development of prevention strategies for these hospitals. Wisconsin was the first state to mandate public health reporting of CRE in 137 acute care, critical access, and long-term care hospitals to CDC’s National Healthcare Safety Network (NHSN).

The State Laboratory of Hygiene (SLH) also receives lab-identified CRE data from clinical labs across the state and shares the data with the Wisconsin Department of Health Services.

From 2013 to 2014, the prevalence of lab-identified CRE was six to seven cases for every 100,000 hospital admissions per year throughout the state. The majority of cases were in the southeastern public health region.

To improve prevention across the state, the Department of Health Services coordinated with local public authorities to form regional collaborative groups of hospitals and healthcare facilities in order to educate about CRE. A CRE toolkit was provided to healthcare facilities, which included information on:

  • Prompt use of transmission-based precautions
  • Notification to receiving facilities
  • Submission of isolates to SLH
  • Screening of potentially exposed patients
  • Education of facility staff, patients, and families

Through this process, we have learned that public health agencies can play a key role in preventing transmission of CRE by creating venues for communication and collaboration among healthcare providers and their partners. The facilitation of local and regional collaboration across multiple healthcare organizations is necessary for optimum care of patients and residents with histories of multi-drug resistant organisms because of transmission of CRE among facilities.

Our goal is to expand this approach to nursing homes on a voluntary basis. In 2014, we conducted nine workshops for nursing homes across the state in hopes that they will begin reporting CRE into CDC’s NHSN database on a voluntary basis.

This is the final post of a 3-part series related to the August 2015 Vital Signs: Making Health Care Safer: Stop Spread of Antibiotic Resistance. Visit to read parts 1 and 2.

Posted on by DHQP

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Page last reviewed: November 18, 2016
Page last updated: November 18, 2016