MDROs (e.g.vre): Prevention and Control in the Community

MDROs (e.g.vre): Prevention and Control in the Community

MDROs: Prevention and Control in the Community Super Bugs are antibiotic resistant bacteria e.g. Methicillin Resistant Staphylococcus aureus (MRSA) Vancomycin Resistant Enterococcus (VRE) other microbes which carry several resistant genes

Super Bug Very dangerous, lethal? Contagious? Very hard to treat?

Super-Bug

MDROs: Prevention and Control in the Community Antimicrobial resistance continues to emerge and spread MRSA, VRE, Carbapenem-resistant Enterobactericeae (CRE) Antimicrobial resistance is a health threat both globally and locally, causing serious institution-acquired and communityacquired infections Antimicrobial resistance results in increased morbidity, mortality, and healthcare costs

VRE What are Enterococci? Enterococci are bacteria found in the stomach and bowels of about many healthy people. They are also found in the mouth and throat, vagina, and on the skin around the anal area. What are Vacomycin-Resistant Enterococci (VRE)? VRE are Enterococci that have become resistant to many common antibiotics ncluding Vancomycin. How common is VRE? VRE in Singapore is still relatively uncommon compared to the USA or UK. The incidence has increased in the last 2 years. We try to keep the situation under control with screening and good infection control How is VRE spread? VRE spreads from person to person is by direct contact, usually via the hands. Indirect contact with surfaces that may have been contaminated is also possible. VRE cannot be spread through droplets or through the air.

Carbapenem Resistant Enterobacteriaceae Enterobacteriaceae is a large family of Gram-negative bacteria such as Salmonella, E coli, Klebsiella, Proteus, Enterobacter, Serratia, Citrobacter Many members of this family are a normal part of the gut flora found in the intestines of humans and other animals Klebsiella, E coli are common causes of UTI, gastro-intestinal and hepatobiliary infections Carbapenems are a class of antibiotics often reserved as a last line for gram-negative bacteria Resistance to carbapenems means there are very few options

RISK ASSESSMENT Risk Assessment Part of Infection Prevention and Control program Objective is to assess potential for spread of cases in facility Reviewed and updated annually - Check incidence and prevalence of MDRO s (medical history, clinical/screening culture results) - Identify high risk patient groups and clusters - Evaluate each MDRO s related infection and transmission rates regularly Develop and implement a MDRO management plan for your organisation and this should be part of your organisation s Infection Control and Prevention Programme

ACTIVE SURVEILLANCE Aims Identify the respective MDROs carriers early so that appropriate precautions can be taken to prevent spread within the facility or organisation. Currently, all public hospitals are doing this either hospitalwide or in high risk patient groups ILTCs will be informed of known MRSA status of patients upon transfer Each ILTC will decide if active surveillance is needed based on their MDROs risk assessment:

Why Screen? Why Screen?

Active Surveillance If MRSA active surveillance, the following is done: i) Specimen collection: 1 nasal swab and 1 swab for axilla and groin, per patient/ resident ii) Specimen should be collected at admission, transfer from facility and discharge

Management of MDRO Patients/ Residents/ Clients For patients with MDRO whether colonised or infected, the following are recommended: Contact Precautions - Hand Hygiene - Apron/ gown and gloves - Room for Contact Isolation (if possible) - Cohort cases with similar organisms

Management of MDRO Patients/ Residents/ Clients Group activities Can the patient participate in group activities? Consider the 3 Cs Ensure that the patient is clean, with drainage, secretions, and excretions contained, and is cooperative in any setting Infected or colonized patients should be permitted to participate in activities if draining wounds are covered, bodily fluids are contained, and the patient observes good hygienic practices

Management of MDRO Patients/ Residents/ Clients Environmental measures: Cleaning protocol regular items and reusable equipment (e.g., IV poles, cuffs, wheelchairs) - Clean and disinfect surfaces and equipment, including items in close proximity to the patient (rails, tables) and frequently touched surfaces in the care environment (e.g., knobs, bathrooms, light switches, call lights, and phones Dedicated equipment - where possible, items should be dedicated to the person who is on Contact Precautions as long as the person requires the items, and then cleaned and disinfected prior to reuse by another patient. A private bathroom is not necessary for the patient provided Standard Precautions, personal hygiene, hand hygiene and environmental cleaning are maintained (e.g., daily and when visibly soiled)

GENERAL PRINICIPLES IN ENVIRONMENTAL CLEANING 1. Environmental cleaning should be done daily 2. Rooms of MDRO (e.g.mrsa) patients/residents/clients should be prioritised for frequent cleaning and disinfection. 3. Checklist may be created to ensure to ensure efficacy of cleaning 4. Equipment is to be disinfected according to manufacturer s recommendations 5. A policy on types of disinfectant must be in place to guide the cleaning process

VRE How susceptible are family members to being infected by VRE? Healthy people are usually not at risk for infection with the VRE. Regular hand washing after caring for the infected family member will help keep VRE at bay. How are VRE infections treated? Generally, VRE colonization does not require treatment. In serious cases, certain antibiotics may be used. However, it is hard to treat because the bacterium is resistant to most antibiotics. Therefore, only those VRE infected people that display signs and symptoms of the illness should be treated Am I (HCW) at risk? VRE is not more contagious than other germs, but if a patient is carrying these germs, it is important to know so that chances of transmission can be reduced with good infection control and in case of infection, appropriate antibiotics can be prescribed.

Super-Bugs or not? Staph aureus, Enterococcus, Enterobacteriaceae are all part of our normal flora