RECOGNITION
- ESBL/MGNB isolated from any culture or alert on iPortal
CARB ISOLATED
- Discuss with infection prevention team
- Strict contact isolation in single room with en-suite
- use gowns and gloves
Patient has clinical signs of Infection
- Check previous microbiology reports
- Discuss empirical treatment with microbiologist
Screen again
- Take swabs for ESBL/MGNB at least 1 day apart
- send rectal swabs, swab from site originally positive
- if catheter still in situ, CSU
- if a productive cough present, sputum
History of carbapenemase-producing Acinetobacter
- Add swab from any wound, chronic ulcer or skin lesion, tracheostomy site
- request ‘screen for carbapenemase-producing Acinetobacter’
Outcome of screens
- Once CPE/CARB has been reported, isolate patient for the entire duration of hospital stay irrespective of subsequent negative screens
Patient transfer
- Before moving patient to any other ward, contact infection prevention team (IPT)
ESBL/MGNB BACILLI OTHER THAN CARB ISOLATED
- Discuss with infection prevention team
- Undertake Standard infection prevention precautions
- Nurse patient in single room, or, if several patients infected/colonised, cohort in single bay
- If urinary catheter in situ, remove if possible
- if catheter needed, use silver-coated catheter
- If surgical antimicrobial prophylaxis required, see relevant guideline in Surgical guidelines
Patient has clinical signs of Infection
- Check previous microbiology results
- Discuss with empirical treatment with microbiologist
48 hr after antimicrobial treatment has stopped
- Send CSU and rectal swab to laboratory
- if stoma or unable to obtain rectal swab, stool sample with reason stated
Keep screening long term admissions
- Take swabs for ESBL/MGNB at least 1 day apart
- send rectal swabs, swab from site originally positive and if catheter still in situ, CSU
Outcome of screening
3 consecutive sets of negative screens
- Check screens taken at least 1 day apart with at least one >48 hr after completion of any antimicrobial treatment
- Patients may be moved from side room or cohort bay
3 consecutive weekly screens positive
- Keep patients in side-room or cohort
- do not send further samples for MGNB/ESBL screening
© 2022 The Bedside Clinical Guidelines Partnership.
Created by University Hospital North Midlands and Keele University School of Computing and Mathematics.
Research and development team: James Mitchell, Ed de Quincey, Charles Pantin, Naveed Mustfa