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I2M&=[7OOZ/&aSYt!#v%SwJ D.)EA8 n7$e&e6._=x֗}2Z+D܁;vk|Lo&YJKɏ \Hݾ RǬʒSW{ UPbѦ^K'5~"⤢'3 I4'kCp|/\k?C#ig@@!J:Ϲ<ݧc6xz{ƒ$꤅Q%0+L4 d)#$LrmLIs5~ZA _`Ln!q40F`)?k#K8/b c0?8@+X6<2oSk++㕬Ao{H4xrN"kLhūy=ϭlRf_[qN˚'E3W~~E9")3%F|m>D]~?s~P̝/t-l lI]'g" F4۠6}"DWmY̽ř2oVQXF/zձc+ضs\t4vPyԙ֞@L!*&ėT7Tf PcX>th)S,qB?"SR:z/$aOV"뿁,CBUG w79-B9 m۶x8=ͮ{^dS¢o곛o}O?vZvɽg$aO&JN-AX]ڬ?J퓑lIPqA;Dxi-zSHR*: MGjBWd_Hr&N@I endstream endobj 25 0 obj << /Type /StructElem /S /Part /P 9 0 R /Pg 7 0 R /K [27 0 R 28 0 R 29 0 R 30 0 R 31 0 R 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R 37 0 R 38 0 R 39 0 R 40 0 R] >> endobj 26 0 obj << /Type /StructElem /S /Part /P 9 0 R /Pg 8 0 R /K [41 0 R 42 0 R 43 0 R 44 0 R 45 0 R 46 0 R 47 0 R 48 0 R 49 0 R 50 0 R 51 0 R 52 0 R 53 0 R 54 0 R] >> endobj 27 0 obj << /Type /StructElem /S /Figure /P 25 0 R /Pg 7 0 R /K [12] >> endobj 28 0 obj << /Type /StructElem /S /H2 /T (Frequently Asked Questions \(FAQs\) for Health Care Personnel Carbapenemase-Producing Organisms \(CPOs\)) /E (Frequently Asked Questions \(FAQs\) for Health Care Personnel Carbapenemase-Producing Organisms \(CPOs\)) /Pg 7 0 R /K [3] >> endobj 29 0 obj << /Type /StructElem /S /H1 /T (Q1: What are carbapenemase-producing organisms \(CPOs\)? ) /E (Q1: What are carbapenemase-producing organisms \(CPOs\)? ) /Pg 7 0 R /K [8] >> endobj 30 0 obj << /Type /StructElem /S /P /E ( A: Carbapenemase-producing organisms are bacteria that produce enzymes that breakdown carbapenems, which render carbapenems and other beta-lactam antibiotics ineffective. CPOs can cause a variety of infections \(e.g., wound, respiratory, bloodstream\), but do not always cause clinical infections; CPOs can also colonize individuals without causing signs or symptoms. Individuals colonized with CPOs are still capable of contributing to transmission and are at risk for progression from colonization to clinical infection. ) /Pg 7 0 R /K [9] >> endobj 31 0 obj << /Type /StructElem /S /P /E (1) /Pg 7 0 R /K [2] >> endobj 32 0 obj << /Type /StructElem /S /H1 /T (Q2: What are carbapenemase-producing resistance genes \(e.g., KPC, NDM, VIM, IMP, OXA-48, OXA-58, OXA-23, OXA-24/40\)? ) /E (Q2: What are carbapenemase-producing resistance genes \(e.g., KPC, NDM, VIM, IMP, OXA-48, OXA-58, OXA-23, OXA-24/40\)? ) /Pg 7 0 R /K [7] >> endobj 33 0 obj << /Type /StructElem /S /P /E ( A: Carbapenemase-producing resistance genes are mechanisms of antimicrobial resistance that give bacteria the ability to produce enzymes that breakdown carbapenems and make an organism resistant to carbapenem antibiotics. These particular carbapenemase-producing genes are concerning because they are located on mobile genetic elements called plasmids, which enable bacteria to share the resistance gene\(s\) with other organisms they come in contact with. ) /Pg 7 0 R /K [4] >> endobj 34 0 obj << /Type /StructElem /S /P /E ( ) /Pg 7 0 R /K [5] >> endobj 35 0 obj << /Type /StructElem /S /P /E (Example: An individual initially identified as having a KPC gene associated with Klebsiella pneumoniae can subsequently have other organisms, like Escherichia coli, detected with the KPC gene as a result of horizontal gene transfer. ) /Pg 7 0 R /K [6] >> endobj 36 0 obj << /Type /StructElem /S /H2 /T (Q3: If a patient has a carbapenemase-producing gene identified and is placed on Enhanced Barrer Precautions, can the patient still have a roommate? ) /E (Q3: If a patient has a carbapenemase-producing gene identified and is placed on Enhanced Barrer Precautions, can the patient still have a roommate? ) /Pg 7 0 R /K [10] >> endobj 37 0 obj << /Type /StructElem /S /P /E (A: Individuals placed on Enhanced Barrier Precautions can have a roommate. To the extent possible, individuals colonized or infected with CPOs should be roomed with individuals that have the same organism\(s\) and/or gene\(s\). Placement of individuals with different genes in a shared room should be avoided as much as possible since these bacteria can acquire multiple resistance genes. If there aren't any other patients/residents with the same gene\(s\) that the patient/resident can be roomed with, consider placing the patient/resident in a room with the lowest-risk individual, such as those without open wounds and without \(or with minimal\) indwelling devices. ) /Pg 7 0 R /K [11] >> endobj 38 0 obj << /Type /StructElem /S /Figure /P 25 0 R /Pg 7 0 R /K [13] >> endobj 39 0 obj << /Type /StructElem /S /Figure /P 25 0 R /Pg 7 0 R /K [14] >> endobj 40 0 obj << /Type /StructElem /S /H3 /T (If you have additional questions, please contact the New Jersey Department of Health HAI/AR Unit at: DOH.CDS.HAIAR.EPI@doh.nj.gov.) /E (If you have additional questions, please contact the New Jersey Department of Health HAI/AR Unit at: DOH.CDS.HAIAR.EPI@doh.nj.gov.) /Pg 7 0 R /K [0 1] >> endobj 41 0 obj << /Type /StructElem /S /Figure /P 26 0 R /Pg 8 0 R /K [12] >> endobj 42 0 obj << /Type /StructElem /S /H2 /T (Frequently Asked Questions \(FAQs\) for Health Care Personnel Carbapenemase-Producing Organisms \(CPOs\)) /E (Frequently Asked Questions \(FAQs\) for Health Care Personnel Carbapenemase-Producing Organisms \(CPOs\)) /Pg 8 0 R /K [0] >> endobj 43 0 obj << /Type /StructElem /S /H1 /T (Q4: If a patient has a carbapenemase-producing gene identified but does not have symptoms, are transmission-based precautions necessary? ) /E (Q4: If a patient has a carbapenemase-producing gene identified but does not have symptoms, are transmission-based precautions necessary? ) /Pg 8 0 R /K [4] >> endobj 44 0 obj << /Type /StructElem /S /P /E (1) /Pg 8 0 R /K [5] >> endobj 45 0 obj << /Type /StructElem /S /P /E ( A: Despite the absence of symptoms, colonized individuals can and do spread CPOs to others, to the environment, and to shared equipment and devices. If a patient has any carbapenemase-producing gene detected, it is critical that they are placed and maintained on either Contact Precautions \(in acute care settings\) or Enhanced Barrier Precautions \(in long-term care settings when Contact Precautions are not indicated\) for all healthcare admissions. ) /Pg 8 0 R /K [1] >> endobj 46 0 obj << /Type /StructElem /S /P /E ( It is important to remember that all individuals colonized with CPOs are at a higher risk for progression to clinical infection. This makes strict adherence to infection prevention and control measures \(e.g., hand hygiene, transmission-based precautions and appropriate PPE use, environmental cleaning and disinfection\) important in the prevention of clinical infections among those already colonized with a CPO. ) /Pg 8 0 R /K [2] >> endobj 47 0 obj << /Type /StructElem /S /P /E ( ) /Pg 8 0 R /K [3] >> endobj 48 0 obj << /Type /StructElem /S /H1 /T (Q5: Are antibiotics responsible for the development of carbapenemase-producing genes? ) /E (Q5: Are antibiotics responsible for the development of carbapenemase-producing genes? ) /Pg 8 0 R /K [8] >> endobj 49 0 obj << /Type /StructElem /S /P /E /Pg 8 0 R /K [9] >> endobj 50 0 obj << /Type /StructElem /S /H1 /T (Q6: Do carbapenemase-producing genes go away? ) /E (Q6: Do carbapenemase-producing genes go away? ) /Pg 8 0 R /K [6] >> endobj 51 0 obj << /Type /StructElem /S /P /E /Pg 8 0 R /K [7] >> endobj 52 0 obj << /Type /StructElem /S /Figure /P 26 0 R /Pg 8 0 R /K [13] >> endobj 53 0 obj << /Type /StructElem /S /Figure /P 26 0 R /Pg 8 0 R /K [14] >> endobj 54 0 obj << /Type /StructElem /S /H3 /T (If you have additional questions, please contact the New Jersey Department of Health HAI/AR Unit at: DOH.CDS.HAIAR.EPI@doh.nj.gov.) /E (If you have additional questions, please contact the New Jersey Department of Health HAI/AR Unit at: DOH.CDS.HAIAR.EPI@doh.nj.gov.) /Pg 8 0 R /K [10 11] >> endobj 55 0 obj << /ca 1 /BM /Normal >> endobj 56 0 obj << /Type /ExtGState /ca 0.0 >> endobj 57 0 obj << /Length 293 /N 3 /Filter /FlateDecode >> stream x}JԂ(28hiRpi"VSAOHStspu+.c(#ARx@?F[V[G@`*dK$O.K o@6`O,f'˘O asx0A6vf 8{c7%opZ:u Q 0Q٣F *Ԑ(SDGACAajgrx]s PxM cvhO> stream x1iAH <8 r endstream endobj 59 0 obj << /Length 1076 /Type /XObject /Subtype /Image /Width 2591 /Height 416 /ColorSpace /DeviceGray /BitsPerComponent 8 /Filter /FlateDecode >> stream x10  >ݷX$ p@y endstream endobj 60 0 obj << /Length 1594 /Type /XObject /Subtype /Image /Width 200 /Height 63 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