Beginning in 2009, Pennsylvania experienced one of the largest and most prolonged outbreaks of invasive group A streptococcus (GAS) within a nursing facility to date. The only known reservoirs for GAS in nature are the skin and mucous membranes of the human host. Therefore, one of the highest-risk patient populations is those who have nonintact skin. In the case example from Pennsylvania, the patient population, at any given time, had several known GAS risk factors (including nonintact skin). Such an observation may indicate that outbreak risk can be assessed, and initiation of proactive intervention may provide opportunities to mitigate risk in order to decrease the probability of an outbreak. Presented herein is a novel framework describing proactive outbreak prevention based on pathogen, population, and environment (P2E) risk assessment. Pennsylvania GAS outbreak facts are used as an example, and the framework is expanded to include carbapenem-resistant Enterobacteriaceae, demonstrating the framework's applicability to a multitude of outbreak scenarios.
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