Download Infection Prevention and Control Team (IPCT) EXTENDED

Infection Prevention and Control Team
(IPCT)
EXTENDED SPECTRUM BETALACTAMASE (ESBL) PRODUCING
ORGANISMS
INFECTION CONTROL GUIDANCE
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Extended spectrum beta-lactamase (ESBL) producing organisms – infection control guidance
Issue No 2, October 2013
Page 1 of 9
Title of Policy:
Extended spectrum beta-lactamase (ESBL) producing
organisms – infection control guidance
Policy Reference:
Issue no 2, October 2013
Scope:
Organisation Wide
Controlled
document:
This document shall not be copied in part or whole
without the express permission of the author or the
author's representative.
Expiry Date:
October 2016
Author:
Gillian Rankin, Infection Control Nurse
Policy application Throughout NHS Ayrshire and Arran
/ Target Audience
Policy Statement:
It is the responsibility of all staff to ensure that they
consistently maintain a high standard of infection control
practice in accordance with this guidance to prevent the
spread of infections from and between patients who are
colonised or infected with ESBL producing organisms.
Last reviewed:
October 2013
Agreed by:
Infection Prevention and Control Policy Review Group
Electronic
approval by:
Mrs Fiona McQueen
Executive Nurse Director
Date:
23 October 2013
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Extended spectrum beta-lactamase (ESBL) producing organisms – infection control guidance
Issue No 2, October 2013
Page 2 of 9
TABLE OF CONTENTS
1.0
INTRODUCTION...................................................................................4
2.0
ANTIMICROBIAL RESISTANCE ..........................................................4
3.0
GENERAL INFORMATION ...................................................................6
4.0
INFECTION CONTROL TRANSMISSION BASED PRECAUTIONS
FOR ESBL PRODUCING ORGANISMS...............................................7
5.0
REFERENCES......................................................................................9
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Extended spectrum beta-lactamase (ESBL) producing organisms – infection control guidance
Issue No 2, October 2013
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1.0
INTRODUCTION
Extended Spectrum Beta-lactamase (ESBL) are enzymes produced by
many species of bacteria which can destroy one or more antibiotics. This
means that ESBL producing organisms are resistant to certain types of
antibiotics which would normally be used to treat such infections. This does
not mean that ESBLs are untreatable, nor do they necessarily present a
greater risk in terms of the number or the severity of infections caused.
However, treatment of ESBLs may require the use of more broad spectrum
and toxic antimicrobial drugs.
The treatment of infections caused by ESBL producing organisms is usually
with carbapenem antibiotics, to which the bacteria are susceptible. However,
patients may be asymptomatic carriers (colonised) and do not require
treatment. Some ESBL producing strains may be present for months or even
years.
ESBL producing organisms include:



Escherichia Coli
Klebsiella species
Enterobacter species
2.0
ANTIMICROBIAL RESISTANCE
2.1
Antimicrobials affected by ESBL producing organisms
2.2
Antimicrobials usually used to treat ESBL producing organisms
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Extended spectrum beta-lactamase (ESBL) producing organisms – infection control guidance
Issue No 2, October 2013
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Note: Resistance to Carbapenems has been identified, it is vital that
ESBL producing organisms are treated ONLY when an active infection is
present.
If advice regarding the treatment of ESBL-producing organisms is required,
then a Consultant Microbiologist or Consultant Physician in Infectious
Diseases should be contacted via University Hospital Crosshouse (UHC)
switchboard.
It is the responsibility of medical staff to follow best practice and NHS Ayrshire
and Arran (NHSAA) guidelines on antimicrobial therapy.
Staff who administer such drugs have a responsibility in ensuring that the
prescriptions have a start and finish date on them, to limit the duration of their
usage.
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Extended spectrum beta-lactamase (ESBL) producing organisms – infection control guidance
Issue No 2, October 2013
Page 5 of 9
3.0
GENERAL INFORMATION
Please click here to access all sections of the Infection Prevention and Control
(IPC) manual, including Section 1 Standard Infection Control Precautions
(SICPs).
Mode of
Transmission
Transmission route will be determined by the organism producing the
ESBL resistance.
Incubation Period
Incubation period will be determined by the organism producing the
ESBL resistance.
Note: Some patients may be colonised with the organism, and are
asymptomatic carriers.
Individuals Most at
Risk
High Risk Clinical
Areas
Low Risk Clinical
Areas
Standard Infection
Control
Precautions
(SICPs)
There are many factors which contribute to the patient becoming
infected or colonised with an ESB producing organism which include:
prolonged hospital stay
prior antimicrobial therapy
the strain of the organism
the site at which the organism has been identified
immunosuppression
the presence of invasive devices or wounds
severe underlying medical conditions
increasing age
Coronary Care Units (CCU)
General Surgical wards
Gynaecology ward
High Dependency Units (HDU)
Intensive Care Units (ICU)
Neonatal Units
Obstetric wards
Oncology/Haematology Units
Ophthalmology ward
Orthopaedic wards
Renal Dialysis Unit (RDU) or renal ward
Urology ward
Vascular ward
Acute and Continuing Care of the Elderly wards
Addiction Services
Community Hospital/GP Units
Dermatology wards
General Medical wards
Learning Disabilities
Mental Health
Outpatient Departments, Health Centres & Clinics
Paediatric wards (except Neonatal Unit)
Rehabilitation wards
Section 1 Standard Infection Control Precautions
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Extended spectrum beta-lactamase (ESBL) producing organisms – infection control guidance
Issue No 2, October 2013
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4.0
INFECTION CONTROL TRANSMISSION BASED PRECAUTIONS
FOR ESBL PRODUCING ORGANISMS
Section 2 Transmission Based Precautions highlighted in this policy document
are additional precautions designed to prevent further transmission to be
used when an individual is suspected or known to have an infectious
agent/disease.
Please click here to access all sections of the Infection Prevention and
Control (IPC) manual, including Section 1 SICPs.
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Extended spectrum beta-lactamase (ESBL) producing organisms – infection control guidance
Issue No 2, October 2013
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Patient
Placement
High Risk Areas
- Symptomatic ESBL positive inpatients in higher risk areas will require isolation in a
single room with the door closed and the implementation of contact precautions
- Patients who are asymptomatic will not require isolation in a single room; however,
this should be discussed with an Infection Control Nurse (ICN) on an individual basis
Low Risk Areas
- ESBL positive inpatients in lower risk areas will require an individual risk assessment
based on symptoms and the isolation prioritisation scoring system
- If assessed as being a significant risk then the patient should be nursed in a single
room using contact precautions and the door must be closed
- If isolated, the risk assessment should be carried out daily and documented in the
patient record
If the patient has been asymptomatic for greater than 48 hours then isolation may be
discontinued. Further advice can be obtained from the Infection Prevention and Control
Team (IPCT).
Hand
Hygiene
-
Hands must be decontaminated as per WHO (World Health Organisation) 5 moments
for hand hygiene:
Before patient contact
Before an aseptic task
After body fluid exposure
After patient contact
After contact with patient zone
Patients should be encouraged to carry out thorough hand hygiene Section 1
Appendix 1 - 4 in the IPC manual
Personal
Protective
Equipment
(PPE)
Plastic aprons and disposable gloves should be worn to prevent direct contact with the
patient or the patient’s immediate environment. Hand hygiene must be carried out
following removal of PPE (see Section 1 Appendix 5 and 6 in the IPC manual)
Linen
-
All linen should be discarded as infected (see Linen Bagging Procedures)
Water soluble bag
Clear plastic bag
Place into a red laundry bag
See Section 1 Appendix 10 Management of Linen
Staff should wear appropriate PPE when carrying out this task (see Section 1
Appendix 5 and 6 in the IPC manual)
Clinical
Waste
All waste must be discarded as clinical waste within the isolation room (see Section 1
Appendix 12 Management of waste at care level area)
Patient Care
Equipment
Equipment should be kept to a minimum. Prior to removal from the room, all
equipment must be decontaminated using a chlorine based solution e.g. Actichlor™.
Please check manufacturer’s instructions for compatibility with cleaning products
Communal facilities such as baths, bidets and showers should be cleaned and
decontaminated between all patients, especially on delivery suites, post-natal wards
and other high risk areas
Section 3 Appendix 3 Cleaning of equipment – staff responsibilities
Hotel
Services
Enhanced cleaning with a hypochlorite solution should be undertaken by hotel service
staff until instructed otherwise
Following the removal of the patient, the room should have a terminal clean carried
out prior to the next patient being admitted (see Section 29 terminal cleaning
guidelines)
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Extended spectrum beta-lactamase (ESBL) producing organisms – infection control guidance
Issue No 2, October 2013
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Transferring
Patients
If possible, do not transfer patients until isolation is no longer required
Prior to transfer, ensure the ward receiving the patient has suitable accommodation.
Inform and discuss with a member of the IPCT
Specimens
Send specimens as clinically indicated
(also refer to the Laboratory Handbook via Athena)
Care After
Death
If the patient is an asymptomatic carrier see Section 1 Standard Infection Control
Precautions
If the patient is isolated due to active infection see.Section 2 Transmission Based
Precautions
See Section 19 Care after death IC guidelines
Patient
Clothing
If a relative or carer wishes to take personal clothing home, staff must place soiled
clothing into a clear plastic bag then into a patients clothing bag. Staff must also ensure
that a Washing Clothes at Home Information Leaflet is issued.
No restrictions
Visitors
For ESBL during the infectious phase, visitors should be offered suitable information.
This includes advice on hand hygiene
If the visitor has a level of direct contact/involvement in the affected person’s care,
then advice on the appropriate use and disposal of PPE as well as hand hygiene
should be provided
For further information please contact the IPCT or the on-call consultant
Microbiologist
Outbreak
situations
Outbreaks can sometimes occur in healthcare and non-healthcare settings. The IPCT
will advise staff in these situations. Staff screening may also have to be undertaken
by Occupational Health
An outbreak should be considered if there are 2 or more cases of suspected ESBL
infection related by person or place
See Section 12 Outbreak Control Plan
Clinical Alert A yellow ESBL sticker must be attached to the clinical alert sheet (located inside the
medical notes). This is the responsibility of ward/department staff.
5.0
REFERENCES
1.
Bissett L, (2007), ESBL-producing Enterobacteriaceae: controlling the
spread of infection, British Journal of Nursing, Vol 16 No 11
2.
Health Protection Agency (2006), Factsheet on ESBLs. Available at
http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1194947330844
(Last accessed 19/04/2013)
3.
Health Service Executive (2013) ESBL Extended-spectrum Beta
Lactamase.
ESBL
information
leaflet
for
patients,
http://www.hpsc.ie/hpsc/Publications/InformationLeafletsfortheGeneral
Public/File,13106,en.pdf (last accessed 19/04/2013)
4.
Health Protection Agency (2013) General Information: Extended
Spectrum Beta Lactamases – Frequently Asked Questions,
http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/ESBLs/
GeneralInformation/ (last accessed 19/04/2013)
5.
Thomson KS (2010), Extended-Spectrum-β-Lactamase, Amp C, and
Carbapenemase Issues, Journal of Clinical Microbiology, Vol 48, No 4
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Extended spectrum beta-lactamase (ESBL) producing organisms – infection control guidance
Issue No 2, October 2013
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