Discovery of first MCR-1 gene in E. coli bacteria found in a human in United States The Centers for Disease Control and Prevention (CDC) is part of a coordinated public health response after the Department of Defense (DoD) announced the discovery of the first MCR-1 gene found in bacteria in a human in the United States. E. coli bacteria carrying the MCR-1 gene was


found in a urine sample from a Pennsylvania woman with no recent travel outside of the U.S. The MCR-1 gene makes bacteria resistant to the antibiotic colistin, which is used as a last-resort drug to treat patients with multi-drug-resistant infections, including carbapenem-resistant Enterobacteriaceae (CRE). The MCR-1 gene exists on a plasmid, a small

piece of DNA that is capable of moving from one bacterium to another, spreading antibiotic resistance among bacterial species.The CDC and federal partners have been hunting for this gene in the U.S. ever since its emergence in China in 2015. Despite some media reports, the Pennsyl-

vania State Health Department investigation has determined that the woman did not have CRE and the bacteria identified is not resistant to all antibiotics (referred to as a pan-resistant infection). The presence of the MCR-1 gene, however, and its ability to share its colistin resis- tance with other bacteria such as CRE raise the risk that pan-resistant bacteria could develop. The investigation is currently focused on iden-

tifying close contacts, including household and healthcare contacts, of the Pennsylvania patient to determine whether any of them may have been at risk for transmission of the bacteria containing the MCR-1 gene. Beginning in fall 2016, CDC’s Antibiotic

Resistance Lab Network will provide the infra- structure and lab capacity for seven to eight regional labs, and labs in all states and seven major cities/territories, to detect and respond to resistant organisms recovered from human samples. State labs will be able to detect new forms of antibiotic resistance — including muta- tions that allow bacteria to survive the effects of the last-resort drugs like colistin — and report these findings to CDC. With this comprehensive lab capacity, state

health labs and regional labs that are part of the network will be able to investigate emerg- ing resistance faster and more effectively, generating better data for stronger infection control among patients to prevent and combat future resistance threats. CDC will also provide new resources to state health departments to support their efforts to stop antibiotic-resistant outbreaks and prevent the spread of antibiotic- resistant pathogens across communities. For more information on the MCR-1 discovery,

see early-detection-new-antibiotic-resistance.html.

competitive in the ASC Best practices keep costs down, standards high by Susan Cantrell, ELS

healthcare providers — and patients — seek ways to cut costs and improve efficiencies. “The number of outpatient procedures has risen dramatically since 1981, and the majority of surgeries performed in the United States now take place in outpatient settings,” wrote the authors of a study published in Health Affairs.1

A . Outpatient

surgeries cost less at ASCs than they do in hospitals and can save time as well, ap- proximately 32 minutes less per procedure, on average. “[Our] findings suggest that ASCs provide an efficient way to meet future growth in demand for outpatient surgeries and can help fulfill the Affordable Care Act’s goals of reducing costs while im- proving the quality of health care delivery.” Winning in the ASC arena means find- ing ways to implement and execute best practices and standards similar to those practiced by hospitals. Although ASCs are working with fewer assets compared to large medical centers, they can find sup- port from a variety of resources specifically designed to help ASCs succeed. The Ambulatory Surgery Center Associa- tion (ASCA) represents ASCs and provides advocacy and resources to assist ASCs in delivering high-quality, cost-effective am- bulatory surgery to its patients. Kay Tucker, Director of Communications, ASCA, said they are dedicated to assisting ASCs to operate efficiently while maintaining a focus on patient safety. Highlighting the similarities between the stringent standards of hospitals and ASCs, she said there should be no question as to whether ASCs are inferior in any way to hospitals — because hospitals and ASCs play by the same rules. “ASCs are well-recognized for their out- standing patient outcomes, patient safety, customer service, and staff and cost efficien- cies,” Tucker said. “ASCs are highly regu- lated and subject to extensive oversight, just like hospitals. Medicare-certified hospital outpatient departments must comply with


mbulatory surgery centers (ASCs) are surfacing across the country with greater speed than ever before as

Centers for Medicare and Medicaid Ser- vices’ (CMS) Conditions of Participation, while Medicare-certified ASCs must comply with CMS’s Conditions for Coverage. Both include rigorous requirements regarding patient safety, governance, operational policies and procedures, and more. “ASCs follow the same nationally and internationally recognized infection- prevention guidelines as hospitals,” con- tinued Tucker. “As one small example, Medicare quality-reporting data released recently shows that more than 99 percent of Medicare-certified ASCs use a safe-surgery checklist. All Medicare-certified ASCs are required to comply with infection- prevention requirements specified in Medicare’s Conditions for Coverage and the Interpretive Guidelines for ASCs.” Visit ASCA’s web site at http://www.ascas- medicarecertification.

ASCA’s Advancing Surgical Care Campaign

Accreditation An important step in establishing credibility is for ASCs to seek accreditation and remain committed to always following those stan- dards. “ASCs seek accreditation for many reasons, including demonstrating the high quality of care they provide, to qualify for Medicare-deemed status, and, in some cases, to meet state licensing requirements,” Tucker noted. “ASCs routinely tell us that the best way to prepare for an accreditation survey is to live according to the standards at all times.” The American Association for Accredi- tation of Ambulatory Surgery Facilities

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