Infection Prevention & Control Care

Champion (IPCCC) Forum

Multi drug resistant organisms

(MDROs)

&

Anti microbial resistance(AMR)

Introduction

Housekeeping

Presentation (MDROs & AMR)

IPC care champion

responsibilities

Evaluation

Session aims

Participants will:

• Have an increased awareness of the differences

between colonisation and infection

• Have an increased awareness of common

MDRO’s

• Know how to appropriately manage residents with

MDRO’s

• Understand the importance of antimicrobial

stewardship

What is a multi-drug resistant organisms?

• MDROs are often called superbugs. They are micro-

organisms such as bacteria, fungi, viruses etc. that have

developed resistance to one or more antimicrobials

(antibiotics for bacteria)

• When micro-organisms are resistant to antimicrobials

infections can be difficult to treat and can cause serious

illness

• These resistant micro-organisms can then persist in the

body (colonisation)

• These micro-organisms can then spread to others and

increase the risk of colonisation &/or infection.

Residents at increased risk of colonisation or

infection by MDROs include:

• Those who have been treated with multiple courses of

antibiotics

• Those who have been in hospital for a long time

• People with long term conditions, weakened immune

systems (in particular, transplant patients, or those in

intensive care)

• Those who have undergone surgery

• People with medical devices (in particular, catheters or drips which have been in place for a long time)

What is colonisation?

• Bodies are covered inside and outside with good and bad

bacteria. If bad bacteria are in the body or on the skin it can

be fine there and not cause problems or infection.

• If a sample or swab is taken bacteria maybe present but not

require treatment.

Comparison between infection & colonisation

Infection

• Pyrexial

• Raised blood results (white cell

count, CRP)

• Wound – swollen, red, pus, hot

, painful, not healing

• Urine – frequency, painful,

dribbling

• Chest – productive

yellow/green cough,

breathlessness, wheezing,

increased respirations

Colonisation

• Apyrexial

• Normal blood results

• Wound - maybe delayed

wound healing e.g leg ulcer,

but no heat

• Urine – asymptomatic

• Chest – clear sputum

Colonisation & MDROs

• You may not know which residents are colonised

• Residents who are colonised do not require isolation unless they have an active

infection

• People with these micro organisms are only contagious if they have an open

wound, diarrhoea, or active infection

• It is advisable for residents with a MDRO to not have close contact with people

with open wounds and catheters

• These micro organisms are able to contaminate the environment

Vancomycin Resistant Enterococci (VRE)

• Enterococci are bacteria found in human and animal

intestines (gut). In some women they are also present in the

vaginal area and urinary tract

• Enterococci can also be found in the environment

• Vancomycin is a strong antibiotic

• Sometimes, enterococci become resistant to Vancomycin (it

does not work against them). This is called vancomycin–

resistant enterococci (VRE).

Carbapenemase-producing enterobacteriaceae

(CPE)

• CPE are bacteria which may live harmlessly in the bowel. If they enter

the bladder or bloodstream they can cause infection

• Carbapenemase is an enzyme which is produced by bacteria which

makes them resistant to the Carbapenem class of antibiotics

• E. coli, Klebsiella and Enterobacter are bacteria which may produce

Carbapenemase (CPE)

• CPE are bacteria which can be difficult to treat.

Extended Spectrum Beta-Lactamases (ESBLs)

• ESBLs live harmlessly in the gut of humans and animals

• ESBLs are enzymes produced by bacteria such as

Escherichia coli (E.coli)

• ESBLs are most commonly associated with urinary tract

infections

• ESBLs can be resistant to a range of frequently used

antibiotics.

Meticillin resistant Staphylococcus Aureus

(MRSA)

• People can be colonised by both Staphylococcus aureus

(SA) & MRSA

• MRSA colonisation is usually found in noses, armpits,

groins and buttocks (loves to grow in warm sweaty areas!)

• Wounds should be covered with an impermeable dressing

• MRSA are usually resistant to the Penicillin family of

antibiotics.

How is MRSA spread

Anyone can get MRSA on their body by:

• Touching someone (who has MRSA on their skin or from an open

wound)

• Sharing personal items (towels; sheets; clothes with someone who has

MRSA on their skin)

• Touching surfaces or objects that have MRSA on them

• S. aureus and MRSA can survive for long periods in the environment

and lives in the dust.*.

Panton-Valentine leucocidin-(PVL)

• Is rare BUT causes publicity and fear

• Causes mainly soft tissue infections (boils)

• More serious infections (necrotising pneumonia)

Risk factors

• Healthcare settings (care homes, hospital wards)

• Household and sexual contacts

• Contacts in social settings/sports: wrestling;

American football; rugby; judo

• Closed community settings: military camps;

gyms; prisons.

When to suspect PVL in the community

A person has recurrent

abscesses

Or

there is a cluster of skin

and soft tissue infections

within a home, household

or social group

How are infections spread?

• Direct spread via hands of staff or residents

• Equipment that has not been appropriately decontaminated

• Environmental contamination

• Remember The Chain of Infection.

www.nhs.uk/conditions

Prevent infections - standard infection control

procedures

• Hand hygiene:

staff, WHO 5 Moments to Hand Hygiene

residents, especially after using the toilet and before meals

visitors & contractors, on entering and leaving

• Personal protective equipment (PPE)

• High standards of environmental cleanliness

• Safe disposal of sharps

• Safe laundry management

• Clinical waste management

Resident admission & discharge

• There are no special transport requirements for a resident

• If a resident needs to go into hospital – inform ambulance

and/or hospital staff of resident’s MDRO status. A risk

assessment can then be undertaken to determine whether

isolation is needed in hospital

• When transferring a patient between one healthcare

environment to another, an Inter-Health and Social Care

Infection Control Transfer Form should be completed. This

must accompany the resident

• Once the resident has been successfully treated they are

able to be discharged home

• Record MDRO status on resident’s file.

Inter Health Care Transfer Form

Notification for a resident carrying or infected with an infectious

organism

Patient / client details: (insert label if available)

Name: Patient name in full

Address:

Address line 1

Address line 2

City, postcode, country

Date of birth: DoB

NHS number: NHS no.

Consultant name: Consultant name

Consultant Contact no: Consultant telephone

No.

GP name: GP name

GP contact no: GP telephone No.

Transferring facility:

Facility name / Details (eg care home,

community hospital, hospice, district nurse,

GP)

Contact name: Transferring facility contact

Contact no: Transferring facility contact no.

Receiving facility:

Facility name / Details (eg care home,

community hospital, hospice, district nurse,

GP)

Contact name: Receiving facility contact

Contact no: Receiving facility contact

Diagnosis: (confirmed organism)

Diagnosis / Confirmed organism details

Infection: Yes☐ / No☐

Colonisation: Yes☐ / No☐

Infection prevention and control precautions required / in place: IP&C details

Antibiotic Guardian

Antibiotic stewardship is important for all of us. Go to:

http://antibioticguardian.com/

Includes:

• Useful AMR video

• Resources for you to use

• Learning tools

• Personal pledges

AMR pledges

• ‘I will prevent infections and therefore the need for

antibiotics in my care home by….’

• ‘I will raise the importance of preventing infections

with residents, staff and visitors in my care home’

• ‘ will avoid the use of unnecessary antibiotics’

• ‘I will use delayed prescriptions where appropriate’

• ‘I will make sure the right antibiotic is given to the

right resident, at the right time, for the right

duration’

Events

European Antibiotic Awareness Day

(EAAD)

18th November 2018

https://antibiotic.ecdc.europa.eu/en

World Antibiotic Awareness Week

12th – 18th November 2018

http://www.who.int/campaigns/world-antibiotic-

awareness-week/en/

Summary

• MDRO’s are bacteria which are resistant to certain

antibiotics

• Colonisation is when there is bacteria present on the skin or

living harmlessly in the gut

• Residents do not usually require isolation unless they have

an active infection

• Wounds should be covered with an impermeable dressing.

• Standard precautions need to be embedded in daily

practice

• Sign up to be an Antibiotic Guardian

• Don’t forget to get your Flu jab.

IPC Care Champion

• Nomination Forms

• Job Profile

• Responsibilities

• Forms available on the IPC team website

InfectionPrevention@lancashire.gov.uk

https://twitter.com/lancsipc

http://www.lancashire.gov.uk/practitioners/health/infection-prevention-and-control.aspx