Antibiotic Resistant Organisms C diff Resistant Organisms Are
Antibiotic Resistant Organisms & C. diff Resistant Organisms Are we running out of antibiotics? Gloves do not replace hand hygiene. May provide perfect moist environment for bacteria growth. QHC currently has an active surveillance program for MRSA, VRE and CPE. 1
Infection Prevention & Control (IPAC) � � � Who we are RNs with IPAC education and experience Contact us any time Monday – Friday 0800 -1600 Extension - 2361 2
Antibiotic Resistant Organisms • MRSA (methicillin-resistant staph aureus) • VRE (vancomycin resistant enterococci) • C. difficile (clostridium difficile) • CPE (carbapenemase producing enterobacteriaceae) 3
MRSA Colonization/Infection � Staphyloccus aureus are bacteria commonly carried on the skin or in the nose ◦ Resistant to the antibiotic methicllin, 20 -30% of the population is colonized on their skin or nose but not ill – these people will have no symptoms � Sometimes staph can cause an infection, most are minor but if left untreated can lead to serious infections (surgical wounds, bloodstream, pneumonia) � Spread by contact with surfaces that have Been touched by someone with MRSA PURPLE DOOR SIGN 4
VRE Colonization/Infection • Vancomycin-resistant Enterococcus (VRE) are normally found in the bowel, female genital tract, urinary tract, and the environment. They are a persistent organism, resistant to many antibiotics and may live in the environment for long periods • Healthy people can have VRE with no symptoms, this is called colonization. • Some have a low resistance to bacteria for many reasons, VRE can cause infections in these individuals • Common VRE infections – urinary tract, bloodstream, wounds associated with catheters or surgical procedures • Transmission is fecal-oral and occurs directly via the hands of patients, family members, and healthcare workers or indirectly from contaminated environment and/or equipment Ø Risks: long term treatment with vancomycin, LOS, recent admissions, weakened immune system, etc. ORANGE DOOR SIGN 5
Temporary changes to how we isolate for VRE and MRSA • MRSA and VRE in private room or cohort organisms together • Meticulous hand hygiene • Please use appropriate signage on the door • Note: no need for gown use for MRSA/VRE at this time • If MRSA infection in the respiratory track, patient would be placed on droplet contact precautions When COVID-19 pandemic resolves we will resume contact precautions for VRE and MRSA using a yellow AAMI level 2 gown and gloves. 6
• C. difficile is hand to mouth transmission • C. difficile infection is often called “antibiotic-associated diarrhea” • Does not affect children under 12 months of age C. diff • Patient should always be in a private room with dedicated equipment Clostridium difficile 7
Risk Factors for CDI � � � � History of antibiotic usage (esp. fluoroquinolones) Immunosuppressive therapy post-transplant Proton pump inhibitors (Pantoloc) Bowel disease & bowel surgery, or any recent surgery Chemotherapy Prolonged hospitalization History of CDI Increased Age GREEN DOOR SIGN 8
Diagnosis and Resolution � Stool must take the shape of the container. Lab will not test solid stool. Lab will only test once every 7 days � Toxins can persist in the stool for weeks. Precautions may be stopped when the patient has not had loose stool in 48 hours AND has resumed a normal stool pattern. (No repeat testing to determine when to stop precautions) � Do not stop contact precautions until terminal clean is done – inform Infection Prevention and Control � Reoccurrence is common (30%) 9
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CPE � � � Carbapenemase-producing Enterobacteriaceae (CPE) are Enterobacteriaceae that are resistant to carbapenem antimicrobials (e. g. , imipenem, meropenem, ertapenem) and all or most penicillin and cephalosporin antibiotics through the production of one or more carbapenemase enzymes Transmission is likely via direct and indirect contact. The site of colonization is the lower gastrointestinal tract. While the dry environment has rarely been implicated in outbreaks, colonization of sinks and shower drains with CPE may be common and transmission events and outbreaks secondary to drain colonization have been reported. An infection caused by CPE is extremely hard to treat and mortality rates are upwards of 50% RED DOOR SIGN 11
Temporary change as to how we isolate for CPE and CDI Non Rated Yellow Gown to be used for CPE and Clostridium difficile Following COVID-19 we will return to using an AAMI level 2 gown and gloves. 12
AROs can present as: Infection Colonization 13
QHC Criteria for Swabbing Patients who received healthcare outside of Canada in the past 12 months. (MRSA, VRE & CPE if indicated) Patients who have been in a hospital outside our LIHN in past 12 months (MRSA, VRE & CPE) Patients coming from Greece, Israel or the Indian subcontinent (Pakistan, India, and Bangladesh and the Himalayan states of Nepal, and Bhutan, Sri Lanka) with or without exposure to healthcare within the past 12 months(CPE) Patients who have been in QHC or any hospital within or LHIN or long term care in the past 12 months (MRSA & VRE) Patients with a length of stay exceeding 30 days (rescreen for MRSA & VRE) and every 30 days after 14
Swabbing and Isolating of AROs VRE/MRSA Isolate-Contact Precautions SWAB POSITIVE YES-3 swabs min. 7 days apart. VRE-rectal/MRSA-nasal/perianal PAST POSITIVE NO YES-1 swab to confirm negative. VRE-rectal/MRSA-nasal/perianal POSSIBLE EXPOSURE NO-unless Outbreak measure YES-2 swabs min 7 days post exposure. VRE-rectal/MRSA-nasal/perianal. 15
Swabbing and Isolating of AROs CPE Isolate-Contact Precautions SWAB POSITIVE YES. Patient who is positive will always be considered positive. Rectal swab upon admission and every 30 days for duration of stay. POSSIBLE EXPOSURE YES. 3 rectal swabs with one swab a minimum of 21 days post exposure. 16
What can we do to stop transmission? � HAND HYGIENE � Additional precautions � Private room / cohort VRE/MRSA � Dedicated equipment / clean equipment between patients � Proper room cleaning � Transport of patients 17
Cleaning Equipment • Clean your hands • Clean your equipment (stethoscope, pens, phone, spectra link phone, etc) with Oxyvir/Excel wipes with gloves (1 minute kill time) • Drinks in the work place must be kept at the ‘designated drink station. ’ Each unit has such an area. • This is diligence because many of the organisms are hand to mouth transmission • Q 5 Medicine has Clean. Slate UV machine that disinfects devices with UV light 18
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