Re: ESBL’s – which ones?

[Michael Wishart]

That didn’t quote the original message like I thought it would, so was a little obscure… try again…

Hi all

Just thought I’d bump this question again, as I didn’t get any responses. Surely someone has an opinion on which gram-negatives need to be managed as MROs?

Thanks
Michael

Michael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this email

On Wed, 28 Aug 2013 02:58:33 +0000, Michael Wishart wrote:

>Hi all
>
>This is a partly microbiology, partly infection control question (like many we are faced with). We are an acute private hospital with a 16 bed ICU and oncology, major orthopaedic and cardiac surgical services. We have changed our main microbiology lab provider in the last few years, so some of the decisions we have made about infection control based on micro reporting now need to be revisited.
>
>The main issue is about what we determine as ‘multi-resistant gram negatives’, and how we then manage those. The lab we used to use only reported certain resistance patterns in certain organisms; the current lab seems to report much more broadly, especially in regard to ESBL-producing organisms. Our ID physician is of the opinion that most ESBL producing organism probably pose very little risk, and we should focus of Klebsiella EBSL producers only from an infection control perspective (ie alerting, additional precautions, etc), but the lab (which also services another major hospital group) reports any gram-negative that is positive for ESBL enzymes they test for (we had our first Aeromonas ESBL-producers reported recently, which kind of kick-started this discussion).
>
>I am of two minds. I appreciate the opportunity to reduce the number of patients we need to place in additional precautions and alert, but I am also concerned we open ourselves up to the potential for spreading ESBL enzymes within our facility. We currently have no evidence that ESBL producing organisms are endemic or established within our facility, and it would be nice to keep it that way. My concern is not so much which gram negatives are more likely to cause actual infection (which is I believe our ID physician’s view), but more the potential for gram negative organisms to share their ESBL enzymes with different gram negative species that ARE more likely to result in actual infection/disease. What I am not clear on is what the risk of this occurring is, and whether alerting and using additional precautions is a useful way to reduce this risk.
>
>I am aware there is a group working on some recommendations for standardisation of reporting gram negative resistance for labs, but I am not sure this will actually address my concerns.
>
>Any thoughts, or processes that your facilities have determined for this issue, would be of value in helping me work through this, and would be gratefully received.
>
>Cheers
>Michael
>
>Michael Wishart
>CNC Infection Control
>Holy Spirit Northside Private Hospital
>627 Rode Road, Chermside, Qld 4032
>t: (07) 3326 3068 | f: (07) 3607 2226
>e: Michael.Wishart@hsn.org.au
>w:www.holyspiritnorthside.org.au
>Please consider the environment before printing this email
>
>
>–
>WARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.
>
>Message protected by MailGuard: e-mail anti-virus, anti-spam and content filtering.
>http://www.mailguard.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 aicalist@aicalist.org.au
>
>To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
>
>You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.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 aicalist@aicalist.org.au

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

Michael Wishart
Infection Control Coordinator
St Vincent's Private Hospital Northside & St Vincent's Private Hospital Brisbane
Brisbane, QLD
michael.wishart@svha.org.au

[Ruth Barratt]

Hi all,
Our approach in our tertiary facilities here in Christchurch, New Zealand may be of interest. A couple of years ago we introduced a risk assessment for ESBLs based on the Swedish work as we have limited single rooms and on average about 10-15 ESBL positive inpatients each day.

The patient is assessed as low, medium and high risk. Low risk patients are nursed with Standard Precautions, no isolation and have dedicated toilet facilities. They effectively have gut colonisation only with no risk factors for spread. E.g. urinary catheter, stoma loose bowels etc.

At that time we rarely saw any Klebsiella pneumoniae isolates as they were primarily E.coli. Now we are seeing more KPN and we would strive to always isolate these patients irrespective of risk factors as there is evidence that Kleb species of ESBL are more transmissible.

I am happy to share our flow chart which was developed for the wards to use.

Cheers

Ruth

Ruth Barratt RN, BSc, MAdvPrac (Hons)
Clinical NurseSpecialist Infection Prevention and Control
e: ruth.barratt@cdhb.health.nz
t: + 64 3 3640 083 or ext.80083
Pager: 8331
Level 5, Riverside Building
Christchurch Hospital | Private Bag 4710, Christchurch
Clean Hands Save Lives!

—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: Monday, September 09, 2013 12:09 p.m.
To: AICALIST@AICALIST.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] ESBL’s – which ones?

That didn’t quote the original message like I thought it would, so was a little obscure… try again…

Hi all

Just thought I’d bump this question again, as I didn’t get any responses. Surely someone has an opinion on which gram-negatives need to be managed as MROs?

Thanks
Michael

Michael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this email

On Wed, 28 Aug 2013 02:58:33 +0000, Michael Wishart wrote:

>Hi all
>
>This is a partly microbiology, partly infection control question (like many we are faced with). We are an acute private hospital with a 16 bed ICU and oncology, major orthopaedic and cardiac surgical services. We have changed our main microbiology lab provider in the last few years, so some of the decisions we have made about infection control based on micro reporting now need to be revisited.
>
>The main issue is about what we determine as ‘multi-resistant gram negatives’, and how we then manage those. The lab we used to use only reported certain resistance patterns in certain organisms; the current lab seems to report much more broadly, especially in regard to ESBL-producing organisms. Our ID physician is of the opinion that most ESBL producing organism probably pose very little risk, and we should focus of Klebsiella EBSL producers only from an infection control perspective (ie alerting, additional precautions, etc), but the lab (which also services another major hospital group) reports any gram-negative that is positive for ESBL enzymes they test for (we had our first Aeromonas ESBL-producers reported recently, which kind of kick-started this discussion).
>
>I am of two minds. I appreciate the opportunity to reduce the number of patients we need to place in additional precautions and alert, but I am also concerned we open ourselves up to the potential for spreading ESBL enzymes within our facility. We currently have no evidence that ESBL producing organisms are endemic or established within our facility, and it would be nice to keep it that way. My concern is not so much which gram negatives are more likely to cause actual infection (which is I believe our ID physician’s view), but more the potential for gram negative organisms to share their ESBL enzymes with different gram negative species that ARE more likely to result in actual infection/disease. What I am not clear on is what the risk of this occurring is, and whether alerting and using additional precautions is a useful way to reduce this risk.
>
>I am aware there is a group working on some recommendations for standardisation of reporting gram negative resistance for labs, but I am not sure this will actually address my concerns.
>
>Any thoughts, or processes that your facilities have determined for this issue, would be of value in helping me work through this, and would be gratefully received.
>
>Cheers
>Michael
>
>Michael Wishart
>CNC Infection Control
>Holy Spirit Northside Private Hospital
>627 Rode Road, Chermside, Qld 4032
>t: (07) 3326 3068 | f: (07) 3607 2226
>e: Michael.Wishart@hsn.org.au
>w:www.holyspiritnorthside.org.au
>Please consider the environment before printing this email
>
>
>–
>WARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.
>
>Message protected by MailGuard: e-mail anti-virus, anti-spam and content filtering.
>http://www.mailguard.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 aicalist@aicalist.org.au
>
>To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
>
>You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.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 aicalist@aicalist.org.au

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.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 aicalist@aicalist.org.au

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

[Author]

Posts