ESBL Care Plan for Patients/Residents /Clients

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Management of Patient/Resident/Client with
EXTENDED SPECTRUM BETA-LACTAMASE (ESBL)
Date
Problem
ESBL Colonization
Goal
Intervention
To prevent transmission of
infectious agents which
are spread by direct and
indirect contact with the
Patient/Resident/Client or
their environment
Staff will adhere to Hand Hygiene policy
Apply Contact Precautions for all close personal care
Precautions:
 Private room (preferred where possible), OR  Precautions in a multi-bed
room
The patient/resident/client may be out of their room for tests, mobilization or
rehabilitation. If leaving their room they must have the permission of their
healthcare provider, wear a clean gown/pyjamas or clean street clothes, have
any wounds covered with fresh dressings and perform hand hygiene on exiting
and re-entering their room. They must not visit public areas within the facility
(unit kitchen, cafeteria, shops/kiosks in main entrance etc.)
Ensure Contact Precaution sign is displayed at the entrance to the room and at
the bedside
o Contact Precautions – wear gown and gloves for all contact with the
patient/resident/client or their environment (which includes the whole room if
single room or bed space if a multi-bedded room)
A surgical grade (120 mmHg) fluid resistant mask (with attached visor), fitted to
the face must be worn when/if irrigating wounds due to risk of splash
Dedicate patient/resident/client toilet facilities and attach patient/resident/client
identification (e.g. MRN & Bed#)
Dedicate equipment to the patient/resident /client and attach
patient/resident/client identifier. Equipment not dedicated must be thoroughly
decontaminated before being removed from the patient/resident/client’s bedspace to be used by another patient/resident/client
Linen, garbage and dishes are treated as routine
Housekeeping:
Cleaning according to VIHA Guidelines, Facility specific
On discharge or transfer from the room, or discontinuation of precautions, notify
housekeeping that a clean must be completed according to current VIHA
Guidelines
Housekeeping shall remove Precaution Sign on completion of designated
Facility clean
To prevent the spread of
ESBL and reduce the risk
of transmission associated
with out of room
Author: Infection Prevention and Control Program Care Plan Working Group
Issuing Authority: VIHA Infection Prevention and Control
Signature
Discontinuation
Date
A diagnosis of ESBL must not delay or inhibit any procedure or test required for
the care of the patient/resident/client
Identify additional precautions required on the test/procedure requisition form
and notify the receiving department in advance of the type of additional
Approved: January 15, 2013
Review Date: January 2016
Date
Problem
Goal
Intervention
procedures or tests
Signature
Discontinuation
Date
precautions and cleaning required
Notify transport staff of additional precautions required
Handwashing is extremely important for staff, visitors and patient/resident/client,
especially before meals and after using the toilet. Regular soap and water or
alcohol based hand rub is recommended
Teach patient/resident/client correct procedure to wash hands and when to
perform hand hygiene
Ensure patient/resident/client information leaflet: Hand Hygiene is given to the
patient/resident/client and visitors
Encourage
Patient/Residents/Clients
with Hand Hygiene
To prevent spread of ESBL
and reduce the risk of
transmission associated
with visitors
Provided visitors of patient/resident/client are healthy, there is no restriction on
visiting. However, the following must be strictly adhered to:
o Visitors must be directed to wash their hands with soap and water on
entering and leaving the patient/resident/client room
o Visitors must use gown and gloves in addition to hand washing if they
are providing close personal care. Guidance must be given by the Most
Responsible Nurse
o Visitors must not visit public areas within the facility (unit kitchen, cafeteria,
shops/kiosks in main entrance etc.) and SHALL NOT use the
patient/resident/client bathroom
ESBL Infection
Treatment of ESBL
infection
Decolonization therapy is not recommended for ESBL colonization
The Most Responsible Physician to coordinate treatment regime for infection
Reculture
Reassess ESBL status of
Patient/Resident/Client
As there is no decolonization therapy, the decision to reculture should be made
in conjunction with the Infection Control Practitioner
Colonized
o Wait 7 days following completion of any antibiotic treatment (topical, oral or
injectable)
o Two sets of swabs 7 days apart must be taken, one set from the rectum and
any other site previously found positive as well as a urine specimen
specifying ESBL screen
o If first set of swabs are positive or negative, must wait 7 days before doing
another set of swabs
Infection
o Wait 30 days post completion of any antibiotic treatment (topical, oral or
injectable)
o Two sets of swabs taken 30 days apart must be taken, one set from the
rectum and any other site previously found positive as well as a urine
specimen specifying ESBL screen
o If the first set of swabs are positive, must wait 30 days before doing another
set of swabs
Date antibiotics and treatments
Author: Infection Prevention and Control Program Care Plan Working Group
Issuing Authority: VIHA Infection Prevention and Control
Approved: January 15, 2013
Review Date: January 2016
Date
Problem
Goal
Intervention
Signature
Discontinuation
Date
discontinued:________________________________________________________
Dates of cultures (at least 7 days if colonized and 30 days if infected: must include
urine and rectum and other sites previously positive)
#1_________________________  Urine
 ESBL positive  ESBL negative
 Rectum
 ESBL positive  ESBL negative
 Other site/s  ESBL positive  ESBL negative
#2_________________________  Urine
 ESBL positive  ESBL negative
 Rectum  ESBL positive  ESBL negative
 Other site/s  ESBL positive ESBL negative
Discontinuation of
Precautions
To discontinue precautions
at the appropriate time
Discharge Planning
Ensure discharge of the
patient/resident/client is
done in a manner to ensure
the risk of transmission is
reduced, and the receiving
facility is fully aware of the
patient/ resident/client’s
diagnosis
Please refer to Table 12: Procedure for Discontinuing Additional Precautions in
the Infection Prevention and Control Manual and following a point of care risk
assessment performed by the most responsible nurse discuss potential removal of
ARO flag with Infection Control Practitioner
If both sets of swabs are negative discuss with the Infection Control Practitioner
the discontinuation of precautions and removal of the ESBL flag from the
electronic record
Most Responsible Nurse notifies Housekeeping a clean is required according to
current VIHA Guidelines
If precautions are discontinued prior to patient/resident/client discharge, ensure:
o Patient/resident/client is helped into a clean gown/pyjamas and housecoat,
o Hand hygiene is performed and the patient/resident/client is brought out of
room
o The bedspace/room is cleaned according to current VIHA Guidelines
o If possible, the patient/resident/client is showered/bathed and bathroom
subsequently cleaned according to current VIHA Guidelines
o Patient/resident/client is helped into a clean gown/clothes
Once bedspace/room has been cleaned by housekeeping in a timely manner,
precautions can be formally discontinued, sign will be removed from entrance to
room and at bedside by housekeeping and the patient/resident/client may return
May discharge home or transfer to another facility
Inform Infection Control Practitioner of any transfers/discharges
Inform receiving caregivers or receiving agency of additional precautions if
required and course of treatment
Inform any transport services of additional precautions if required
See also the Infection Prevention and Control Manual
Author: Infection Prevention and Control Program Care Plan Working Group
Issuing Authority: VIHA Infection Prevention and Control
Approved: January 15, 2013
Review Date: January 2016
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