ESBL UTI in RAC

[Vanessa Davis]

Dear Clever People
We have a resident who has been diagnosed with ESBL UTI. They have been
commenced on ABx.

What additional precautions should be implemented for this resident who
lives in her own room with an ensuite.

Based on what I have read, My guess is:
1) Gloves when changing continence aids / toileting.
2) ? plastic gown (? Long or ? Short sleeve)
3) diligence with Hand hygiene (resident and staff)
4) ? Additional cleaning of bathroom
5) none of the above
6) something else

Many thanks for your guidance
Vanessa Watkins

RN, Quality Manager, IPC Lead
Donwood Community Aged Care
11 Diana Street, Croydon, Vic
(03) 9845 8509
vwatkins@donwood.com.au

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[Michael Wishart]

Hi Vanessa

The document cited below is based in Queensland, and local epidemiology needs to be considered. But the need for specific, targeted strategies for prevention of transmission of ESBLproducing organisms in residential care settings is not clear, and will also possibly depend upon the species of organism (eg in QLD, ESBL production in E.coli is not considered a trigger for transmission based precautions).

There is conflicting evidence available on the merits of including ESBL-producing organisms
in a targeted resistance mechanism-specific approach. It is recommended that acute and
high-risk health services assess local epidemiology and perform an assessment of risk to
determine the requirements of the local approach for ESBL-producers. An important factor
to consider is that current laboratory procedures utilise the tests for ESBL-producers to
detect carbapenem resistant organisms; this is an important step to determining if CPE are
present.
The assessment of risk should include the expertise of infection prevention and control
practitioners, infectious diseases physicians and medical microbiologists. It is further
recommended that infection prevention and control programs maintain awareness for
increased numbers of infections with ESBL- producers in order to monitor for outbreaks. In
the event of increased numbers, the local approach should be re-assessed.
For other health services that are not usually considered high risk for MRO infection (e.g.
residential aged care, outpatient settings, community-based settings), the decision to
implement an organism- or resistance mechanism-specific program other than for CPE
should be made per health service based on factors including local epidemiology, risk of
transmission and risk of infection.
Different combinations of strategies may be used for different health services, and the
appropriate strategy may be a risk assessment approach that is applied to each individual
client with an MRO colonisation or infection. For example, in residential aged care, use of
isolation and contact precautions may not be required routinely for management of
residents who are colonised with an MRO, but these measures may be put in place when a
risk assessment indicates they are required. For example, a resident who currently has an
infection with an MRO, or a resident colonised with an MRO who has trouble with hygiene
behaviours.

Management of multi-resistant organisms (health.qld.gov.au)

My recommendation would be (based on the understanding that the patient did not have an indwelling urinary catheter, and resided in a single room with their own ensuite) that standard precautions would be sufficient in this setting. Some of your listed options, to me, are actually what should be part of standard precautions (eg good hand hygiene by all carers, gloves when handling contaminated items (eg used continence aids), apron when splashing is likely) and should be used for all client/resident contacts.

Hope this helps you consider the most appreciate approach.

Cheers
Michael

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
M +61 448 954 282 | T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

St Vincents Private Hospital Brisbane | 411 Main Street KANGAROO POINT QLD 4169
M +61 448 954 282 | T +61 7 3240 1208 | F +61 7 3240 1166
E michael.wishart@svha.org.au |
W https://www.svphb.org.au

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From: ACIPC Infexion Connexion On Behalf Of Vanessa Davis
Sent: Wednesday, 15 June 2022 3:58 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] ESBL UTI in RAC

Dear Clever People
We have a resident who has been diagnosed with ESBL UTI. They have been commenced on ABx.

What additional precautions should be implemented for this resident who lives in her own room with an ensuite.

Based on what I have read, My guess is:
1) Gloves when changing continence aids / toileting.
2) ? plastic gown (? Long or ? Short sleeve)
3) diligence with Hand hygiene (resident and staff)
4) ? Additional cleaning of bathroom
5) none of the above
6) something else

Many thanks for your guidance
Vanessa Watkins

RN, Quality Manager, IPC Lead
Donwood Community Aged Care
11 Diana Street, Croydon, Vic
(03) 9845 8509
vwatkins@donwood.com.au

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to acipclist@acipc.org.au

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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to acipclist@acipc.org.au

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