News

 by Gillian Robinson

Multidrug resistant organisms

Multidrug resistant organisms – an update for residential care

The increase in bacteria that are resistant to antibiotics is now a major concern for healthcare providers across the world. Recently the UK’s top doctor, Dame Sally Davies, described antibiotic resistance as ‘serious a threat as terrorism’, predicting that people may die from routine post operative infections within 20 years as there would be no effective antibiotics available.

 

Multidrug resistant organisms (MDRO or MRO) are organisms that are resistant to several antibiotics to which they would normally be susceptible or two or more classes of antibiotics1. This means that the choice of antibiotics to treat an infection with an MDRO is usually not the first one and may have limited effect.

 

The MDRO that are most commonly encountered in residential care are MRSA (methicillin resistant Staphylococcus aureus) and extended-spectrum β-lactamase (ESBL) producing organisms. However there are some new kids on the block, which, although seen more in the acute healthcare sector, are finding their way into our residential care facilities. These very resistant superbugs include Vancomycin resistant enterococci (VRE) and Carbapenem resistant enterobacteraciae (CRE).

 

Some of the characteristics of these MDRO are summarised in the table below

Summary of MDRO characteristics

MDRO Normal habitat Infections Mode of transmission
MRSA Skin (nares, groin) Skin, urinary tract, chest, wound Contact – colonised or infected skin/ulcer

Contaminated items/surfaces
ESBLs Bowel Urinary tract, wound, pneumonia Contact with faecal or urine contaminated items. Contact with colonised wound/ulcer
VRE Bowel Urinary tract, wound, pneumonia Contact as for ESBLs

Contaminated environment
CRE Bowel Urinary tract, wound, pneumonia Contact as for ESBLs

 

 

High prevalence rates of MDRO colonisation in long term and aged residential care facilities are frequently reported in the literature. Although MDRO are often introduced into a facility from a resident who has recently been in hospital or has had multiple courses of antibiotics, they can spread easily through ARC. This may be due to poor infection prevention and control (IPC) practices, poor facility design or inadequate number of toilets or merely through social contact between residents. However despite the high rates of MDRO in residential care, it does not appear that residents are at greater risk of infection with these organisms.

 

Residential care facilities can play their part in helping to reduce the spread of MDRO by having an effective infection prevention and control programme which includes the following specific to MDRO:

  • the use of standard IPC precautions and adherence to good hand hygiene practices
  • Additional IPC measures when indicated
  • surveillance of infections
  • antimicrobial stewardship e.g. reducing inappropriate use of antibiotics for asymptomatic bacteriuria.
  • Informing the emergency department or ward of the resident’s MDRO colonisation if admitted to hospital. This is important because additional precautions may be necessary in the acute hospital setting.

 

The care of a resident with an MDRO in an ARC facility must reach a balance of the needs of the resident to live a normal life within their ‘home’ and the responsibility to the wider society to prevent further transmission of the MDRO, which contributes to the increase in antibiotic resistance.

 

Staff and colonised or infected residents should understand the methods of spread of the MDRO and use suitable precautions to break this chain of infection transmission. In many cases this will be the use of routine standard precautions, particularly hand hygiene.

 

A risk assessment for each resident should be undertaken and the precautions tailored to their risk factors for spread. For example, emptying and handling urinary catheters and bags increases the risk of spread of ESBLs and apron and gloves should always be worn for this task.

 

Most MDRO colonise the bowel so faecal incontinence is always a risk factor for transmission.

For some of the more resistant organisms such as VRE and CRE, it is advisable that the colonised resident has their own room and toilet facilities and that staff wear a gown/apron and gloves for all cares that involve direct contact with wounds, emptying catheter bags, toileting or other intimate cares.

By ensuring staff are informed, regularly use standard precautions and good hand hygiene practices and implement antibiotic stewardship, together we can help reduce the rate of increase in MDRO in our society.

  1. Ministry of Health. 2007. Guidelines for the Control of Multidrug-resistant Organisms in New Zealand. Wellington: Ministry of Health

 

Ruth Barratt RN, BSc, MAdvPrac (Hons)

Independent Infection Prevention & Control Advisor

Infectprevent@gmail.com

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 by hcsl

Electronic records and computer use in residential care facilities

I remember years and years ago hearing about the coming of the paperless society!  Do you recall that?  Have we achieved it?  If anything, we’re surrounded by more and more paperwork.  I receive enquiries on a regular basis from disgruntled nurses that are bogged down in paperwork and wanting to know if there is a simpler way to do things that will allow them time to get back to hands-on nursing; spending time with their residents.

I’m more than happy to help you with freeing up your time and still achieve all the necessities of documenting service provision.  One way to do this is using smart computer software.  I realise that up until recently our industry has not been ready for this however with the surge in uses of Facebook and other social networking sites, computers are not as intimidating as they once were!

I’m committed to getting your nurses back on the floor while working on the basis of continuous improvement and providing excellence in care based on evidence based practice.  In order to help me develop the tools you need I’d appreciate you taking a few minutes to complete this quick and simple survey.

Thank you for your time and look forward to getting a solution that will allow you to get out of the office and back to your residents!

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 by hcsl

Introduction to Health and Disability Services Standards 2008

The Health and Disability Services Standards 2008 come into effect on 1 June 2009. They replace the Health and Disability Standards 2001.

These are largely revised Standards rather than new Standards and are focused on outcomes for consumers.

In the main, changes involve updates or amendments designed to reduce duplication in the Standards and provide greater clarity and consistency. Therefore providers who are compliant with the current Standards can anticipate they will have few issues becoming compliant with the revised Standards.

The revised sector-agreed Standards are the result of three years extensive collaboration with many groups including consumers, providers, government and non-government agencies and the Ministry of Health.

They have been structured in a new way that will make it easier to review and update parts of them in the future, in order to keep pace with new trends and developments.
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For more information view http://www.moh.govt.nz/certification

in News
 by hcsl

Your most valuable asset

You choose them but what are your choices based on?· Yes, we’re talking about your staff!· Maybe one of your key staff members has just resigned so your instant reaction once you’ve accepted the fact they’re leaving, may be to advertise and get their position re-filled.· Wait just a minute though!· Is that position in it’s previous form the best option for ensuring the smooth running of that shift and achieving the best for the residents and the operational needs of the facility?

This may be just the opportunity to restructure some roles and look at the positions held within the organisation while clarifying whether the current structure is the best option.· Who have you consulted in making this decision?· Have your staff been complaining about anything lately or making suggestions for change?· Are you listening to their suggestions?·

Your staff truly are your best asset as they work the roles and know all the hold ups and loss of efficiency that is currently occurring on their shifts.· They will also have ideas on how things can be improved if you give them the time to value their suggestions and test their ideas.· People are unlikely to offer that information which is valuable to you unless you provide the opportunity and an atmosphere that welcomes input from everyone involved in the organisation.

In working with clients conducting employee surveys, one of the most frequently noted opportunities for improvement from responses is in the area of valuing staff.  How are you doing on that score? Is staff contribution recognised in a way that is meaningful to the individual staff members taking into consideration that all staff may have different things that motivate them?

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