AGENCY NAME
CLINICAL POLICY AND PROCEDURE
SUBJECT: ANTIBIOTIC RESISTANT ORGANISMS:
- Vancomycin - Resistant Enterococci (VRE)
- Methycillin / Oxacillin- Resistant Staphylococcus Aureus (MRSA)
- ESBLs- extended-spectrum beta-lactamases (which are resistant to cephalosporins and monobactams)
- PRSP - Penicillin-resistant Streptococcus pheumoniae
Purpose: To prevent occurrence and spread of antibiotic resistant organisms.
Policy: Patients with identified antibiotic resistant infections will not be denied admission to the VNAB. All patient care employees will be oriented to and will practice Standard Precautions.
Definitions: VRE and MRSA are the most commonly encountered multidrug-resistant organisms in patients residing in non-hospital healthcare settings. Enterococci are part of the normal flora in the intestinal tract and are a common cause of nosocomial infections. Enterococci, like many other organisms, have developed resistance to certain antibiotics. Vancomycin Resistant Enterococci (VRE), although not especially virulent, the lack of effective therapy for invasive infection and the potential for transfer of vancomycin resistance to other bacteria, i.e.: staphylococcus aureus has made the control of VRE a public health concern. Of note is that patients can be colonized with VRE and remain undetected. It is believed that all patients who ever have had a positive culture for VRE should be considered colonized. Colonization means that the organism is present in or on the body but is not causing illness. Infection means that the organism is present and is causing illness. Modifications of precautions should be decided on basis of risk factors for transmission and not on the basis of culture results.
Antibiotic resistant organisms do not pose an infection risk to health care workers. However, they can transiently carry this organism and serve as vehicles for transmission to others.
Procedure:
The following procedures will be followed when caring for a patient with known antibiotic resistant infections:
1. Handwashing:
Use an antimicrobial soap at the beginning of each visit, after any contact with the patient, articles or equipment used in the care of the patient, after removing gloves or other barriers and at the end of each home visit.
2. Personal Protective Equipment
Use gloves when providing direct patient care- bathing, transferring, changing linens, toileting, dressing changes or handling other body fluids. Masks, goggles are/ or gowns are to be worn during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions or cause soiling of clothing. If the caretaker's clothing will have substantial contact with the patient, environmental surfaces, or items in the patient's room then a gown should be worn. It may be necessary to wash hands between tasks and procedures on the same patient to prevent cross-contamination of different body sites.
5. Equipment:
After your own equipment (BP cuffs, stethoscopes etc.) has made patient contact, the equipment should be wiped off with Diachlor towelettes (diluted bleach) and immediately returned to your supply bag. This allows for bacteria kill time while in transit to the next patient home.
6. Specimen Transport:
Specimens are to be double bagged and transported in a hardboard container. The hardboard container is not to be returned to clinician's bag.
7. Environmental surfaces:
Patients and families are to be instructed in care of the home environment: Frequently touched surfaces such as: Bedside tables, siderails, commodes, bathroom toilets, sink countertops and doorknobs should be cleaned every 24 hours with a household cleaning agent or diluted bleach solution. Use gloves when cleaning, remove promptly, wash hands immediately. Linens should be changed and washed if they are soiled and on a routine basis.
References:
1. Morbidity and Mortality Weekly Report: “Recommendations for Preventing the Spread of Vancomycin Resistance. Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC).” September 22, 1995/Vol.44/No.RR-12.
2. State of New York, Department of Health Memorandum. Series 55-14, 10/10/95. Subject: Supplemental Infection Control Guidelines for the Care of Patients Colonized or Infected with Vancomycin-Resistant Enterocci (VRE) in Hospitals, Long-Term Care Facililities and Home Health Care.
3. Edmond, Michael B.; Wenzel, Richard P.; and Pasculle, A. William. Vancomycin Resistant Staphlococcus aureus: Perspectives on Measures Needed for Control. “Annal of Internal Medicine.” Volume 124, No.3, February 1966, pp.329-334.
4. IC Newsletter, Vl 4, no. 5. Guidelines for Long Term Care Facilities for the control of VRE/MRSA, Mass DPH, May 97; PH Circular Letter DHCQ-5-97-362 Control Guidelines for VRE; MRSA, Utah DPH, dept. of epidemiology 96; VRE Ract Sheet, Partners, 96; Rise of Antibiotic Resistant Infections, Ricki Lewis, PhD., 9/95
5. Centers for Disease Control and Prevention, National Center for Infectious Diseases Division of Healthcare Quality Promotion. CDC website www.cdc. gov. Antimicrobial Resistance 12/4/2000.
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