r the next 10 years. research projects including a launch of superheavy rockets will be removed from the programme. the economy is being hit hard by plunging oil prices and western sanctions in the conflict in ukraine. lots more on the news developing stories on aljazeera.com. resistant entero bacteria, a bacterium resistant to standard drugs. >> that didn't just make people sick, it may have killed them. it's called cre and reported to be in all but three u.s. states and is the latest in a frightening line-up of organisms figuring out how to kill you

before you can kill them. guests include a professional who is treating it. and a director on the front lines. it's "inside story". the full name carbopenantresistant makes you glad medicine adopts the short and cre. this bug can be deadly. doctors at the ronald reagan medical center believe many have been exposed to cre. two patients died. the spread of the infection was possible by a medical

treatment. scopes. because of the complexity which is necessary for the life-saving procedures that are performed with the scopes, they are very, very difficult to clean. >> the specific procedure is called e.r. cp or endoscopic retro raid. the mda issued this statement: a medical instrument that spreads germs is a problem. but don't let that distract you

from the underlying threat. there's more and more of these microscopic things that remain alive and dangerous even when we hit them with the drugs meant to kill them. mercer c.d. ip, staph and there are others - super-bugs this time on the programme, how they got to super and the dangers to you on "inside story". let's begin a look with a doctor, infectious disease specialist from the mao clinic. welcome to the programme. me. >> what does cre do inside the body that makes you ill or could threaten your life? >> what it means is it's a bacteria that is resistant to one of the really last lines of defense in terms of aind biotics, it's not just the

resistance, but the bacteria. such as e-kohli can cause ure yinary tract infection, it's antibiotics. >> if a patient has cre in his or her system where it's not supposed to be. body? >> sure. we all have bacteria within our body. escaping and causing infection. when they set up shop and have resistance to antibiotics, when they escape, those resistant bacteria can be harder to retreat than in they were the run of mill highly susceptible organisms. is it hard to figure out that is what is bugging a patient.

how do you eliminate other causes of illness to get down to the idea of infection with a pathogen like this one. >> unfortunately, often it takes a while to find out it's resistant, rather than a susceptible organism. if you use the bladder or the you rin sight that a patient might have, you may identify with the bacteria. usually it's a few days later, 48 hours later that you find out what antibiotics it's susceptible to, and you find out it's a resistant organism. >> a patient is laying in a bed, they feel lousy and have been in the hospital longer than they were supposed to be, and they are sick with what you figure outside is a pervasively resistant organism. how do you treat them if all the

drugs that you use in your war chest don't work? >> it becomes very challenging. thankfully some of these c.r.e.s are susceptible. the first line of drugs are likely not going to work. we end up using some of the older drugs that we have not used in the past. they don't work as well or have a higher risk of toxisty. we use drugs that may not be the best against that organism or may possibility, you know, have the risk of causing harm in certain ways. you have to treat the organism. available. >> so far you have been defeated, you dosed someone with what you hope may work. is there a point at which a person gets sicker and starts to get better

where their body kicks in and works out a defense or is there some people where there is no defense and it will kill them. depends on factors. oven the antibiotics don't help on their own. it just helps the immune system clear the infection. there are situations where you can get an infection with a highly resistant organism. getting control of the infection, in addition with antibiotics, people survive, because these are more resistant, the antibiotics we select will not be as good and often can caused toxicity. >> have you treated patients bacteria? >> i have treated patients with widely resistant bacteria. thank fully we don't have a rampant problem with this, as you will see in other parts of

the country or world. we do occasionally see it. of course, we are careful making sure infection are in control, and making sure we have infections. >> do you have to isolate that person. do they have to spend a lot more time in hospital. >> we end up isolating the patient, making sure people who are going into the room are wearing a gown and a glove in addition to routine hand hygiene. that is on top of the routine such as hand hygiene. so that we don't spread these patients. >> doctor, an infectious disease specialist and former fellow at the epidemic intelligence services. thank you for being with us. >> thank you so much. >> we'll be back with more

"inside story" after a short break. when we return we talk about how hospitals are work toing shore up defenses -- working to shore up defenses against the spread of super-bugs in patients. stay with us, it's "inside story".

>> monday on "techknow". >> we should not be having earthquakes in texas. >> the true cost of energy hits home. >> my yard is gone. >> are we destroying our way of life? >> contaminated water from the fracking activities come here.

>> they stick it into the core of the earth. >> but this cutting-edge technology could be the answer. >> the further of fracking is about the water. >> protecting the planet saving lives. >> how do you convince a big oil company to use this? >> "techknow". monday, 6:30 eastern. only on al jazeera america. >> part of al jazeera america's >> special month long evironmental focus fragile planet welcome back to "inside story". i'm ray suarez, maybe you noticed and with no small concern that people are contracting some of the new antibiotic difficult to treat infections while they are patients in hospitals. it may have come from minor surgery or following an accident and end up with hospitalisation for infection. that was the case with the latest super-bug.

with rising concern about growing resistance. any specialist says the easiest one to control is the one you don't g in the first place. we are joined by an epidemiologist, and an infection control director at the center. >> have we, over time, identified the culprits for many or most or a good share of the hospital-acquired affections. how are people getting them. >> hospital acquired infections are a diverse group. you can get an infection from pretty much anything that is stuck into you or any procedure done to you in hospital. and medic u louse attention to hygiene and cleanliness is needed to prevent the infections. do we know, as important as good

infection control is at any time whether there are certain bugs in certain part of the country that are making the rounds, the ones you can puck up in boston, as opposed to tampa, or in phoenix as opposed to minnesota. >> there is and isn't. the patterns that we sea, the cre that is mentioned is common coulds the country and could be picked up anywhere. there are differences in regional variation in the specific bacteria, it's a little different to the one in l.a. there's a different one in new york, and there are bacteria in patients in chicago. >> do you have an early warning

system where it if you do have an outbreak in one part of the country, that every other hospital in that area or around the area knows that it's a problem. that it's here. >> c.d.c. provides alerts that come to us when there's an outbreak associated with a device, contaminated medication and how authorities keep us up to date on what is happening in the region, but these resistant back tear ya are endemic, part of the bacteria found across the states. hospital. >> what are the kinds of things that hospitals are doing to cut done the incidents. is there low-hanging fruit, things that are relatively cheap to do or result.

>> the cheapest and easiest thing to do is hand hygiene. doctors, nurses, people that bring the today dray, everyone needs to wash their hands before they enter a patient's room. before they do tasks and after changing you're yinary kath attars. at our hospital. we have upwards of 60 to 80,000 hand hygiene opportunities every day in two of our - if you count two of our three hospitals. so there's a lot of opportunity and sometimes people miss those. >> all right. so sometimes people miss those. is there anything a patient can be doing, should be doing on their own behalf. so that they are not only acted upon, but actors in this drama infections. >> yes. hospitals have to report infection rates on a lot of

different websites, to the state and to the government. they appear on different websites like leapfrog or hospital compare. it's important for consumers tos recognise that hospitals coming out with things like "we are having a problem with", are the ones looking hard trying to find problems. hospitals, you don't hear about these things. it can be difficult for a consumer. to ask them if they are doing anything particularly with the cleaning. endoscopes. >> you hear about different bugs that have developed pervasively antibiotic resistant strains. i wonder as there are more of

these, whether we have to look at the way hospitals are designed and the way human being come into contact with each walls. >> do we have to look at e.r.s, patient waiting rooms, and start to think differently about the way people cough, breathe, touch each other and the chairs and the floors and all the physical atmoss they are there. >> that's something that infection control teams are doing in every hospital across america. they are rethinking a lot of these things, during cold and flu season, it's routine to have waiting ors. one for sick kids, one for well kids. we use tracts making sure that patients are not able to leave their room, because we can't let them contact other patients.

we require the health care providers to wear gowns, gloves, masks so they don't carry the patient. >> money is difficult to discuss. does this change the cost profile of a hospital stay in some drastic way that the public should understand. if you catch mercer when you are in a hospital for something else, have you blown the budget for somebody. an insurance company hospital or your own pocket. >> absolutely. the people that pay the most are the patients. every hospital stay complicated by health care associated infection can be 10 to $100,000 more expensive, sometimes more than that. in some cases medicare won't

pay the hospital, they won't pay for your stay. sometimes injures covers the cost. it's cheaper to wash our hands. >> thank you, great to have you with us. >> it's time for a break. when we return, we'll widen the focus to growing antibiotic resistance. are the things people do helping these organisms defeat our best medicines, and how do we stop it. that's ahead on "inside story". >> fall of saigon, forty years later. >> we have no idea how many were killed. >> unanswered questions, a botched withdrawal lives lost. examining the impact that still resonates today. a special report starts tuesday, 10:00 eastern. on al jazeera america.

we're back with "inside story" on al jazeera america. i'm ray suarez. this time on the programme we have been looking at cre, the latest infectious bacterium to become immune to multiple antibiotic medicines. maybe you have heard reports

from asia of malaria that is not treatable with drugs, or the variety of tuberculosis resistant to almost every cugdrug to fight that scourge. are we on the cusp of a new earee ear eareeear earee era. we joined by a doctor and specialist in infectious diseases. welcome to the programme. let's begin with an understanding of why the list of diseases that are no longer treated by our most reliable drugs is growing. >> thank you for having me. it's a problem that has been brewing for some time, it's natural evolution.

we lose a lot of antibiotic. we use main in the host setting. when we do, the bacteria have little choice but to figure out way to survive the onslaught. they mutate and acquire genes result. >> are human being making the problem worse by not using drugs as prescribed or not using them the best way. i think we do better. many patients who don't have infections get antibiotics in case. as well, people demand

antibiotics when they have a viral infection, allergies. all contributing to the overuse of antibiotics. we are colinized with bacteria. we shift it just a bit. we run of the risk of being organisms. >> once we make a commonly used drug against an infection no longer effective, we move to second and third level drugs, does that mean that we'll be spending more money making people more sick because the medicines tend to make them sicker as a side effect, or enjoy less success in fighting back against infection. in many cases it's all of the above. we try to use the less expensive drugs first.

trying to keep costs down. second line are more ex-panesive. often they are. and second line because they don't work as well as the first line. sometimes they are less effective. it's no that typical that they are coccyx, some are more toxic. it is true that we are better off with the first line drugs. all this occurs when we are not able to use them. >> are we developing pathogens that nothing we already have will work against them? >> without any question. stories from southern california point to that fact. these are drugs where it's

difficult to find any agents. they don't tend to infect people who are not compromised in a hospital, but if you are in hospital and ill. they can ba director. in fact, they are big problems knew. >> does that means there'll have to be a revolution in pharma. is anyone taking it on. do we have drugs that will take the place of some of the ones that we over time found are no longer effective. >> that is one of the no so hidden problems. the reality is 20 years ago, 20 pharmaceutical companies were involved in the darch and development of antibiotics.

since that time, and the recognise that antibiotics are not as propertible as other lines, most pharmaceutical companies exited the field. there are smaller companies out there trying to develop antibiotics. they don't have the capital. we are in a difficult position with resistant c.r.e.s . that there's not a lot in the pipeline treating them for 5-10 years. the federal government has got ebb involved and nia is interested in the area. the now. >> over the years i've down a

lot of stories in africa, asia and africa america. a lot of the poorest, the cheapest drugs are taken off line by the use of drugs in a way that creates the resistance. is that the case with some of the most dangerous diseases. >> it is certainly true with certain diseases and in particular tuberculosis. if you don't take the full course of therapy, and in particular if you don't take the appropriate dose, you can promote resistance by doing that. the situation is different with the routine bacteria. in that case there isn't any evidence that taking prolonged courses prevent resistance. when you think about it. taking prolonged causes provides the resistance bugs when they

colonize you with an jirnt where they can multiply. we are in hospital, there's a lot of research to figure out how short we can make the antibiotic courses. we'll be better off the less we take. >> thank you for being with us. >> my pleasure. >> that's all for this edition of "inside story". we want you to talk back to your television, visit facebook and give us feedback on what you hear on the programme. we invite you to follow us on twitter. the handle is ajinsidestoryam. see you next time. in washington, i'm ray suarez.

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