Guidelines for the Prevention and Control of Antimicrobial …

MANITOBA HEALTH, SENIORS AND ACTIVE LIVING

Guidelines for the Prevention and Control of Antimicrobial-Resistant Organisms

Manitoba Health, Seniors and Active Living (MHSAL) develops provincial infection prevention and control guidelines to provide evidence-based practice recommendations using documents developed at the national level such as - The Public Health Agency of Canada (PHAC), Canadian Agency for Drugs and Technologies in Health (CADTH) - and at the international level, such as the Centres for Disease Control and Prevention (CDC), Healthcare Infection Control Practice Advisory Committee (HICPAC) and World Health Organization (WHO) as well as other current literature.

The MHSAL Guidelines for Infection Prevention and Control of Antimicrobial-Resistant Organisms (AROs) replaces the Manitoba Guidelines for the Prevention and Control of Antibiotic- Resistant Organisms (AROs) (2007) and the Admission Screening Statement for Methicillin- Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococci (VRE) for Acute Care Facilities and Surgical Centres (2007).

These guidelines have been developed by a working group of Infection Prevention and Control, Infectious Diseases, Occupational Health, Laboratory and Public Health Specialists with expertise in acute tertiary and community hospital care, long-term care and community based care.

Although not regulatory in scope, the intent of these guidelines is to assist in standardizing infection prevention and control practices throughout the province. Regional Health Authorities (RHAs) and other health care facilities/organizations are expected to develop policies and procedures based on these guidelines. Screening or placement of patients on additional precautions may be enhanced based on local epidemiological trends, outbreaks and available resources.

The purpose of the MHSAL Guidelines for the Prevention and Control of Antimicrobial-Resistant Organisms (AROs) is to provide a framework for development of policies and procedures to ensure that screening, prevention and control measures are effectively used.

The guiding principles used in developing these guidelines include: 1. Limiting transmission of antimicrobial-resistant organisms within all health care settings. 2. Minimizing development of infections with antimicrobial-resistant organisms in patients in all health care settings. 3. Promoting patient safety in all health care settings. 4. Achieving these goals in a fiscally responsible manner. 5. Providing evidence ? based best practice recommendations. 6. Updating the antimicrobial-resistant organism guideline in a timely manner, as required.

This guideline, whenever possible, has been based on published research findings. Where there is insufficient published research, consensus by experts in the field has been used to provide recommendations for specific practices.

The information in this guideline was current at the time of publication. Scientific knowledge and technology are constantly evolving. This guideline will be a working document with updates and revisions when current scientific evidence and literature require changes.

Although the guidelines will be updated periodically, practitioners are responsible for ensuring the most recent knowledge is applied for each case.

- 2 Guidelines for the Prevention and Control of Antimicrobial-Resistant Organisms

November 27, 2018

TABLE OF CONTENTS

Abbreviations....................................................................................................................................................... 6 Glossary of Terms............................................................................................................................................... 7

PART A - BACKGROUND RELEVANT TO CONTROL OF ANTIMICROBIAL-RESISTANT ORGANISMS........14

1. Introduction............................................................................................................................................. 14 2. Background (Acquisition of AROs)....................................................................................................... 14 3. Epidemiology.......................................................................................................................................... 16 4. Antimicrobial Stewardship.................................................................................................................... 17 5. Routine Practices and Additional Precautions................................................................................... 19 6. ARO Management in Long-Term Care................................................................................................ 19

PART B - INFECTION PREVENTION AND CONTROL RECOMMENDATIONS FOR

ANTIMICROBIAL-RESISTANT ORGANISMS...............................................................................................20 1.Methicillin-Resistant Staphylococcus aureus (MRSA) Guidelines for Health Care Settings......... 20

1.1 Identification/Notification of MRSA.......................................................................................... 22 1.2 Admission Screening ............................................................................................................... 22 1.3 Surveillance Cultures to be Performed to Identify MRSA......................................................... 23 1.4 Refusal of Screening................................................................................................................. 23 1.5 Flagging/Deflagging of Patient Record................................................................................... 23 1.6 Patient Accommodation and Placement.................................................................................. 23 1.7 Personal Protective Equipment (PPE)....................................................................................... 23 1.8 Non-Critical Patient Care Equipment....................................................................................... 23 1.9 Waste, Laundry, Dishes and Cutlery......................................................................................... 23 1.10 Laboratory Specimens............................................................................................................ 24 1.11 Environmental Control/Housekeeping................................................................................... 24 1.12 Patient Health Record............................................................................................................ 24 1.13 Personal Documents (e.g. Power of Attorney, Paneling Papers, Advanced Care Directive) .24 1.14 Duration of Additional Precautions........................................................................................ 25 1.15 Handling of Deceased Bodies................................................................................................ 25 1.16 Treatment or Decolonization.................................................................................................. 25 1.17 Subsequent Cultures for Persistent Carriage......................................................................... 25 1.18 Management of MRSA Positive Patient When they Leave their Room.................................. 26 1.19 Management of MRSA Positive Patient in the Operating Room............................................ 26 1.20 Management of Neonate Born to MRSA Positive Mother..................................................... 27 1.21 Discharge/Transfer between Facilities.................................................................................... 27 1.22 Home Visit/Pass with Health Care Worker, Companion or Family......................................... 28 1.23 Visitor Visiting an MRSA Positive Patient................................................................................ 29 1.24 MRSA Positive Patient Visiting Other Patients....................................................................... 29 1.25 Patient Requiring Rehabilitation............................................................................................. 29 1.26 Patient Requiring Recreational Therapy................................................................................. 30 1.27 Management of Patient on Mental Health Unit..................................................................... 30 1.28 Management of Contacts....................................................................................................... 30 1.29 Outbreak Management.......................................................................................................... 31 1.30 Surveillance............................................................................................................................ 31 1.31 Management of Pet/Animal Visitor........................................................................................ 31 1.32 Modifications for Additional Precautions in Long-Term Care ................................................ 32

- 3 -

Guidelines for the Prevention and Control of Antimicrobial-Resistant Organisms November 27, 2018

1.33 Modifications for Additional Precautions in Ambulatory Care .............................................. 32 1.34 Modifications for Additional Precautions in Home Care ....................................................... 32 1.35 Modifications for Additional Precautions in Pre-hospital Care .............................................. 32 2. V ancomycin-Resistant Enterococci (VRE) Guidelines for Health Care Settings............................ 33 3. Extended-Spectrum Beta-Lactamase (ESBLs) for Health Care Settings........................................ 36 4. C arbapenemase-Producing Enterobacteriaceae (CPE) Guidelines for Health Care Settings..... 37 4.1 Identification/Notification of CPE............................................................................................. 40 4.2 Admission Screening................................................................................................................ 40 4.3 Surveillance Cultures to be Performed to Identify CPE............................................................ 40 4.4 Refusal of Screening................................................................................................................. 40 4.5 Flagging of Patient Record....................................................................................................... 40 4.6 Patient Accommodation and Placement.................................................................................. 41 4.7 Personal Protective Equipment (PPE)....................................................................................... 41 4.8 Non-Critical Patient Care Equipment....................................................................................... 41 4.9 Waste, Laundry, Dishes and Cutlery......................................................................................... 41 4.10 Laboratory Specimens............................................................................................................ 41 4.11 Environmental Control/Housekeeping................................................................................... 41 4.12 Patient Health Record............................................................................................................ 42 4.13 Personal Documents (e.g. Power of Attorney, Paneling Papers, Advanced Care Directive).. 42 4.14 Duration of Additional Precautions........................................................................................ 42 4.15 Handling of Deceased Bodies................................................................................................ 42 4.16 Treatment or Decolonization.................................................................................................. 42 4.17 Subsequent Cultures for Persistent Carriage......................................................................... 43 4.18 Management of CPE Positive Patient When they Leave their Room..................................... 43 4.19 Management of CPE Positive Patient in the Operating Room............................................... 43 4.20 Management of Neonate Born to CPE Positive Mother........................................................ 44 4.21 Discharge/Transfer between Facilities.................................................................................... 44 4.22 Home Visit/Pass with Health Care Worker, Companion or Family......................................... 45 4.23 Visitor Visiting a CPE Positive Patient..................................................................................... 46 4.24 CPE Positive Patient Visiting Other Patients.......................................................................... 46 4.25 Patient Requiring Rehabilitation............................................................................................. 46 4.26 Patient Requiring Recreational Therapy................................................................................. 47 4.27 Management of Patient on Mental Health Unit..................................................................... 47 4.28 Management of Contacts....................................................................................................... 47 4.29 Outbreak Management.......................................................................................................... 48 4.30 Surveillance............................................................................................................................ 48 4.31 Management of Pet/Animal Visitor........................................................................................ 48 4.32 Modifications for Additional Precautions in Long-Term Care................................................. 48 4.33 Modifications for Additional Precautions in Ambulatory Care............................................... 48 4.34 Modifications for Additional Precautions in Home Care ....................................................... 48 4.35 Modifications for Additional Precautions in Pre-hospital Care .............................................. 48 5. Other Antimicrobial-Resistant Gram Negative Bacilli (GNB) Guidelines for Health Care Settings...................................................................................................... 49 5.1 Identification and Notification of Other Antimicrobial-Resistant GNB..................................... 49 5.2 Flagging/Deflagging of Patient Record................................................................................... 49 5.3 Screening.................................................................................................................................. 49 5.4 Additional Precautions-Contact Precautions............................................................................ 50 5.4.1 Acute Care........................................................................................................................... 50

-4-

5.4.2 Modifications for Additional Precautions in Long-Term Care.............................................. 50 5.4.3 Modifications for Additional Precautions in Ambulatory Care............................................. 50 5.4.4 Modifications for Additional Precautions in Home Care...................................................... 50 5.4.5 Modifications for Additional Precautions in Pre-hospital Care............................................ 50 5.5 Other Infection Prevention and Control Management Practices............................................. 50 6. O ther Emerging Antimicrobial-Resistant Organisms........................................................................ 52

PART C - COMMUNITY CARE........................................................................................................................................53

1. T ransfers of ARO Colonized or Infected Patients To and From Facilities...................................... 53 2.Home Care .............................................................................................................................................. 53 3. G roup Homes for the Physically and Mentally Challenged............................................................. 54 4. D octors Offices/Outpatient Clinics/Dental Offices/Travel Clinics................................................... 54 5.Pre-hospital Care.................................................................................................................................... 54 7. C ommunity-Associated MRSA (CA-MRSA)......................................................................................... 55

PART D - O CCUPATIONAL HEALTH..............................................................................................................................57

1. HCW Exposed to an ARO..................................................................................................................... 57 2. HCW Infected with an ARO.................................................................................................................. 57

2.1 Work Assignment Modification ............................................................................................... 58 2.2 Clearance to Return-to-Work/Assignment Following Work Modification ............................... 58 2.3.1 HCW with an ARO infection of the lower arms or hands: ................................................... 59 2.3.2 HCW with an ARO infection on other areas of the skin: .................................................... 59 3. HCW Who has been Colonized with an ARO..................................................................................... 59 3.1 Nasal Colonization of MRSA without Discharge ..................................................................... 59 3.2 Nasal Colonization of MRSA with Discharge............................................................................ 59 3.3 Decolonization ......................................................................................................................... 60 4. Outbreak Situations............................................................................................................................... 60

PART E - S URVEILLANCE.................................................................................................................................................62

1. ARO Surveillance Recommendations: ................................................................................................ 62

PART F - A PPENDICES.....................................................................................................................................................63

APPENDIX A - F ACT SHEETS.......................................................................................................................................63

APPENDIX B - G UIDELINES FOR SPECIMEN COLLECTION ...............................................................................70

APPENDIX C - M RSA POSITIVE CONTACT MANAGEMENT ALGORITHM......................................................72

APPENDIX D - S TEPS FOR OUTBREAK MANAGEMENT ....................................................................................74

PART G - B IBLIOGRAPHY................................................................................................................................................78

-5-

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download