SECTION 11.4 VANCOMYCIN RESISTANT ENTERCOCCUS (VRE)

Transcription

1 SECTION 11.4 VANCOMYCIN RESISTANT ENTERCOCCUS () Introduction Definitions Associated with Risk Groups Signs and Symptoms Source Mode of Transmission Diagnosis Treatment Screening Transport Communication Advice to Residents/Clients and Families Advice to Healthcare Workers Antibiotic Use Notification of Infectious Diseases Infection Prevention and Control Measures in the Residential/Long Term Care Setting Infection Prevention and Control Measures in the Day Care Setting Infection Prevention and Control Measures in the Home for Staff Developed by Niamh Mc Donnell, Liz Forde, Patricia Coughlan and Maire Flynn In conjunction with Dr Bartley Cryan Consultant Microbiologist, Dr William Dibb Consultant Microbiologist Date developed August 2012 Approved by Cork and Kerry Infection Prevention and Control Committee Kerry Infection Prevention and Control Committee Reference number IPCG 11.4/ 2012 Revision number 0 Revision date 2015 or sooner if new evidence becomes available Responsibility for Infection Prevention and Control Nurses review HSE South (Cork & Kerry) Page 1 of 7

2 Introduction Enterococcus are normal bacteria flora of the human and animal bowel and female genital tract. E. Faecalis is the predominant species in humans and causes about 90% of clinical infections; E. faecium is isolated with increasing frequency. Enterococci are relatively poor pathogens, usually causing colonisation rather than infection. Definitions Associated with stands for Vancomycin Resistant Enterococcus also referred to as Glycopeptide Resistant Enterococcus (GRE). are enterococci that have become resistant to vancomycin or other antibiotics that may have usually treated them. Colonisation/Carriage: The presence of multiplying micro-organisms without disease or illness. Infection: The term is used to refer to the deposition and multiplication of bacteria and other micro-organisms in tissues or on the surface of the body with an associated host reaction. Majority of resident/clients are colonised with. When a resident/client is colonised with, he/she may carry it in the bowel or other site such as in urine or a wound without symptoms. Some residents/clients develop infections with. infections like infections from other bacteria vary from mild to severe and depend on many other factors such as the site of infection, age, and other illnesses that the residents/client may have. Risk Groups Residents/clients at risk for infection or colonisation include: Oncology and Transplant patients Residents/clients with indwelling catheters Haemodialysis clients Residents/clients who have recently been hospitalised especially in high dependence units e.g. ICU Residents/clients who have received multiple antibiotics especially vancomycin and/or third generation cephalosporins. Signs and Symptoms The majority of residents/clients colonised with do not have any signs or symptoms present. When residents/clients have an infection caused by their signs and symptoms will vary depending on where the infection is present e.g. there may be redness if there is a wound infection caused by. Source The major source of is the colonised/infected person and the environment where they are being cared for. Mode of Transmission can spread by: Direct resident to resident contact. Indirectly via transient carriage on hands of healthcare personnel. Contaminated environmental surfaces or resident/client care equipment. HSE South (Cork & Kerry) Page 2 of 7

3 Diagnosis is identified by taking a sample from a site such as urine specimen or a rectal swab and sending it to the Microbiology lab to be tested. It takes approximately three days for the result to come back Treatment Healthy people who carry in their bodies (colonised) do not need treatment. Antibiotic therapy may be needed for serious or invasive infections. Screening There is no indication for routine screening for. If there is doubt or concern about the management of a client with staff should in accordance with local arrangements contact the Consultant Microbiologist, the infection control nurse or the general practitioner and follow the advice given. Transportation/Resident Movement Standard Precautions apply to the transportation or movement of residents with a If a resident with a needs to be transported by ambulance, his/her status should also be communicated at the time of booking so appropriate arrangements can be made. A risk assessment of the resident/client to be transferred and the other resident/client being transferred needs to be carried out. Communication Healthcare facilities should ensure that residents/clients who are found to be colonised/infected with are informed of this and provided with appropriate information. Suitable factsheets should be provided If a resident/client with is attending or being admitted to an acute hospital then the hospital should be informed that the resident /client has been/is positive. If the resident /client is to be admitted to a long term care facility then the facility should be informed that the resident /client has been/is positive. Advice to Residents/Clients and Families Residents/clients with do not generally present a risk to their community and should continue their normal lives without restriction. In the home is no more harmful than other normal bacteria that people carry on their skin and are exposed to every day. is not a contraindication to admission to a healthcare facility or a reason to exclude an affected person from activities/treatment. People with are advised to carry out good hygiene practices. Hand hygiene should be preformed after using the bathroom or touching any wounds or devices as a matter of routine rather than the fact that they have. Advice to Healthcare Workers No special precautions beyond Standard Precautions are generally required for the care of residents/clients with. Antibiotic Use The routine use of prophylactic antibiotics is not recommended because of the tendency to encourage the emergence of resistant organisms. HSE South (Cork & Kerry) Page 3 of 7

4 Notification of Infectious Diseases is not a notifiable infectious disease. Infection Prevention and Control Measures in the Residential/Long Term Care Setting Precautions Required Standard Precautions apply to the care of all residents colonised/infected with. Hand Hygiene Good hand hygiene as per the WHO Moments for Hand Hygiene reduces the risk of spread of any multi drug resistant organism including. Alcohol hand gel is recommended for use on visibly clean hands. Residents should be facilitated to carry out hand hygiene after using the toilet and before meals. Personal Protective Equipment Disposable gloves and a plastic apron should be worn when handling blood/body fluids and when performing wound care/catheter care/aseptic procedures as per Standard Precautions. Staff must carry out a risk assessment considering the task to be carried out, the risk of exposure to blood/bodily fluids etc to determine the PPE required if any. Cleaning and Decontamination of Equipment Routine cleaning with detergent and warm water is sufficient. If items are soiled with blood or bodily fluids clean and decontaminate in accordance with the manufacturers instructions, immediately after use and before use on another resident/client- For majority of items clean using a neutral detergent and water and disinfect using a hypochlorite 1,000 parts per million (ppm) e.g. Klorsept/Milton, alternatively use a one step product -combined detergent and hypochlorite 1,000 ppm e.g. Chlor clean. Cleaning and Decontamination of the Environment Daily cleaning with detergent and warm water is recommended for environmental cleaning. Chemical disinfectants are not recommended for routine cleaning. If the environment is soiled with blood or bodily fluids clean and decontaminate in accordance with the manufacturers instructions, immediately after use and before use on another resident/client- For majority of items clean using a neutral detergent and water and disinfect using a hypochlorite 1,000 parts per million (ppm) e.g. Klorsept/Milton, alternatively use a one step product -combined detergent and hypochlorite 1,000 ppm e.g. Chlor clean. Laundry Treat laundry as per standard precautions. Used laundry should be washed at either 65 C (150 F) for not less than 10 minutes or preferably 71 C (160 F) for not less than 3 minutes. Laundry contaminated/soiled with blood/bodily fluids such as urine and faeces should be placed in an alginate or water soluble bag and sluiced in the washing machine using the appropriate sluice cycle followed by a hot wash where temperatures should reach the same as for used linen. Please refer to section 9 Laundry for further information. HSE South (Cork & Kerry) Page 4 of 7

5 Infection Prevention and Control Measures in the Day Care Setting Precautions Required Standard precautions apply to the care of all clients colonised/infected with. Hand Hygiene Good hand hygiene as per the WHO Moments for Hand Hygiene reduces the risk of spread of any multi drug resistant organism including. Alcohol hand gel is recommended for use on visibly clean hands. Residents should be facilitated to carry out hand hygiene after using the toilet and before meals. Personal Protective Equipment Disposable gloves and a plastic apron should be worn when handling blood/body fluids and when performing wound care/catheter care/aseptic procedures as per Standard Precautions. Staff must carry out a risk assessment considering the task to be carried out, the risk of exposure to blood/bodily fluids etc to determine the PPE required if any. Cleaning and Decontamination of Equipment Routine cleaning with detergent and warm water is sufficient. If items are soiled with blood or bodily fluids clean and decontaminate in accordance with the manufacturers instructions, immediately after use and before use on another resident/client- For majority of items clean using a neutral detergent and water and disinfect using a hypochlorite 1,000 parts per million (ppm) e.g. Klorsept/Milton, alternatively use a one step product -combined detergent and hypochlorite 1,000 ppm e.g. Chlor clean. Cleaning and Decontamination of the Environment Daily cleaning with detergent and warm water is recommended for environmental cleaning. Chemical disinfectants are not recommended for routine cleaning. If the environment is soiled with blood or bodily fluids clean and decontaminate in accordance with the manufacturers instructions, immediately after use and before use on another resident/client- For majority of items clean using a neutral detergent and water and disinfect using a hypochlorite 1,000 parts per million (ppm) e.g. Klorsept/Milton, alternatively use a one step product -combined detergent and hypochlorite 1,000 ppm e.g. Chlor clean. Laundry Treat laundry as per standard precautions. Used laundry should be washed at either 65 C (150 F) for not less than 10 minutes or preferably 71 C (160 F) for not less than 3 minutes. Laundry contaminated/soiled with blood/bodily fluids such as urine and faeces should be placed in an alginate or water soluble bag and sluiced in the washing machine using the appropriate sluice cycle followed by a hot wash where temperatures should reach the same as for used linen. Please refer to section 9 Laundry for further information. HSE South (Cork & Kerry) Page 5 of 7

6 Infection Prevention and Control Measures in the Home for Staff Precautions Required Standard Precautions apply to the care of all clients colonised/infected with. Hand Hygiene Good hand hygiene as per the WHO Moments for Hand Hygiene reduces the risk of spread of any multi drug resistant organism including. Alcohol hand gel is recommended for use on visibly clean hands. Residents should be facilitated to carry out hand hygiene after using the toilet and before meals. Personal Protective Equipment Disposable gloves and a plastic apron should be worn when handling blood/body fluids and when performing wound care/catheter care/aseptic procedures as per Standard Precautions. Staff must carry out a risk assessment considering the task to be carried out, the risk of exposure to blood/bodily fluids etc to determine the PPE required if any. Cleaning and Decontamination of Equipment Sharing of equipment is not an acceptable practice in the home, equipment must be dedicated for the patient/client for example walking frame. Routine cleaning with detergent and warm water is sufficient. If items are soiled with blood or bodily fluids clean and decontaminate in accordance with the manufacturers instructions, immediately after use and before use on another resident/client- For majority of items clean using a neutral detergent and water and disinfect using a hypochlorite 1,000 parts per million (ppm) e.g. Klorsept/Milton, alternatively use a one step product -combined detergent and hypochlorite 1,000 ppm e.g. Chlor clean. Cleaning and Decontamination of the Environment Daily cleaning with detergent and warm water is recommended for environmental cleaning. Chemical disinfectants are not recommended for routine cleaning. If the environment is soiled with blood or bodily fluids clean and decontaminate in accordance with the manufacturers instructions, immediately after use and before use on another resident/client- For majority of items clean using a neutral detergent and water and disinfect using a hypochlorite 1,000 parts per million (ppm) e.g. Klorsept/Milton, alternatively use a one step product -combined detergent and hypochlorite 1,000 ppm e.g. Chlor clean. Laundry Treat laundry as with Standard Precautions. Contaminated laundry should be washed after other washing is done and it should be at the hottest wash suitable for the fabric to be washed. Always check the washing labels on the clothing carefully. If using a temperature below 60 c use a biological washing powder. If clothing are soiled with e.g. faeces, loosen with toilet paper and place in the toilet using your gloves, place the clothes in the machine, wash the clothes on a cold wash, followed by a hot wash with detergent as per section 9 Laundry. HSE South (Cork & Kerry) Page 6 of 7

7 References and Bibliography Centres for Disease Control and Prevention (1995) Recommendations for Preventing the Spread of Vancomycin Resistance Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC), Morbidity and Mortality Weekly Report, 44(rr12) Guidelines For The Control Of Glycopetide Resistant Enterococci (GRE) In Hospitals: Joint working party of the Hospital Infection Society (HIS), Infection Control Nurses Association (ICNA) and the British Society of Antimicrobial Chemotherapy (BSAC). veillancesystemearss/referenceandeducationalresourcematerial/enterococci/ National Disease Surveillance Centre (2001) A Strategy for the control of Antimicrobial Resistance in Ireland. Report of the Subgroup of the Scientific Advisory Committee of the National Disease Surveillance Centre. Dublin: National Disease Surveillance Centre. HSE South (Cork & Kerry) Page 7 of 7