[Ruth Barratt]

Hi Cate,
Great you are looking at your local risk re. these issues.
I can share with you my NZ experience – in most of New Zealand North Island, Auckland and upper north of NZ which has a similar epidemiology picture to yours re MRSA e.g. overcrowding , high community rates of nmMRSA etc. Most NZ North Island hospitals removed contact precautions for nmMRSA patients many years ago and have not seen an increase in hospital transmission of MRSA which is actually mostly community acquired.

* Re ESBL the common community ESBL- E.coli colonised patients are not isolated either unless they have a high risk factor for spread. Again the majority of the ESBLs are community acquired. In Christchurch over 5 years ago we introduced a risk matrix for isolation of ESBL based on organism e.g. ESBL Klebsiella is always in CP, and patient risk factors for spread. Again no change in hospital transmission. Of course it freed up single rooms, improved transfer times from ED and was better for the patients.
* Re. plastic aprons versus long sleeved plastic gowns. Most of the UK routinely use plastic aprons for these types of MRO CPs where there is minimal contamination anticipated. However it may be that one type of gown stocked on the wards is better than two.
* I also think Susan Jains recent journal article presents a good argument for no gloves for dry MRO patients very well.

Cheers
Ruth

Ruth Barratt RN, BSc, MAdvPrac (Hons)
PhD Candidate and Research Assistant
Centre for Infectious Diseases and Microbiology
Westmead Institute for Medical Research
University of Sydney
Email: ruth.barratt@sydney.edu.au
rbar5856@uni.sydney.edu.au
Mobile: 0468 352 335
ORCID ID:https://orcid.org/0000-0002-8930-6414

From: ACIPC Infexion Connexion on behalf of Cate Coffey
Reply-To: ACIPC Infexion Connexion
Date: Monday, April 1, 2019 at 7:24 PM
To: “ACIPCLIST@ACIPC.ORG.AU”
Subject: Gloves,gowns, contact precautions and colonised nmMRSA

Hi everyone,
just after your thoughts on glove and gown use in contact precautions. We are currenlty reviewing the management of transmission based precautions in our facility. Our local profile of MROS’s include very almost no CPE, minimal MRSA, high rates of nmMRSA which is widespread in the community , increasing ESBL, minimal other gram negative MRO’s. We are reviewing the possiblilty of using standards precautions for patients who are colonised with nmMRSA. Clearance swabs are problematic as patientss often retrun to homes with overcrowding and high rates on nmMRSA. There is currently no PCR testing for MRSA/nmMRSA available in our jurisdiction, therefore 3 swabs are taken for culture.
We would also like to remove longsleeve plastic gowns and replace with plastic aprons for contact precautions unless there is a risk of blody fluid exposure. Gloves seem to poorly affect Hand Hygiene complance despite significant education and would like you views and experience on this.
The literature seems inconclusive but as this would be against NHMRC guidelines ,can you let me know if you have any advice regading the changes we would like to implement ?
Thanks everyone

Cate Coffey | Clinical Nurse Consultant
Infection Prevention and Control Unit | Central Australia Health Service
Northern Territory Government
Alice Springs Hopsital, Gap Rd, Alice Springs
GPO Box 2234, Suburb, NT Postcode
p … 08 89517737
e … cate.coffey@nt.gov.au http://www.nt.gov.au/health

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