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