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The challenge: Patients with multiple antibiotic-resistant organisms
Volume Arjrll
11 Number
2
1983
At the end of my talk, I ask for questions. If there are none, or only a few, I ask if anyone is curious about anything on the list. I may ask a specific person to tell me what a word on the list means or what a certain topic has to do with infection control. These are some of the questions from the orientees. “Doesn’t ‘media’ refer to TV and radio?” “What is the difference between isolation and precautions?” ” Scabies! In the hospital?” I provide an answer sheet (Fig. 2) to anyone who wishes to have it.
The emergence of multiple antibiotic-resistant organisms within the hospital setting is becoming a major problem. The ICP has a major responsibility in preventing cross-contamination and nosocomial infections caused by multiple antibiotic-resistant organisms. In addition, it is important for the ICP to educate the staff regarding the ramifications of multiple antibiotic resistant organisms and related outbreaks. Over the past several years the Hospital Infection Control Committee in our hospital noticed an increase in the number of multiple antibiotic-resistant isolates reported from the microbiology laboratory. A highly resistant organism is defined as an isolate that is resistant to a majority of the aminoglycoside sensitivity discs, especially amikacin. The urinary tract was the predominant site of infection in these patients. A majority of these isolates were Pseudomonas aenrginosa. From 1978 through 1979 a total of 74 resistant P. aemginosa isolates were reported from the urinary tract. In addition, clustering of patients had been noted on several ward locations. Several of these patients continue to be infected when readmitted, thereby providing an additional reservoir for infectious agents. The following guidelines were developed for the prevention and control of resistant P. aeruginosa or other resistant isolates from the urinary tract.
In evaluating the puzzle’s usefulness, I find the time spent to be more relaxed than it was, and from what I am told by the orientees, it is a fun way to learn that infection control is not as intimidating as they had supposed. Barbam L. We&w, R&l., B.S. infection Control Survailiance Nurse Greenbrier Valley HbspEZal Ronceverte, West Virginia
Multiple antibiotic-resis,tant urinary tract infections in catheterized’ patients wifl be managed as foollows: 1. The ICI? will notify the unit~that the p&em has a rrezrltiple a~t~~Q~~~r~~~a~t i~&te. 2. The nursing staff will init e liamoperator ing action with the data te (DTO): Enter the statement “C~~~~~~~~ Urine-IbMtiple ~tib~ti~~~~~~~t Organisms” in the patient care plans. 3. Patient will be 2~ a room qhoqe no other patient h cwthete transfer is necessary, n~ing $ range the transfer via Bed Controli Bed Control will have a copy of this policy and ‘procedure . 4. Handwasbing before and after patient contact is mandatory. 5. Initially the Foley bag will be labeled “Contaminated Urine” by the ICP. The charge nurse will then be responsible for labeling each new bag. The charge ntrrse will also be responsible for the initial labeling of the bag on weekends and holidays. 6. To alert all other patient care personnel, the ICP will label the outside of the p;aitiortt chart “Contaminated Urine-Multiple Antibio$icResistant Organism.“ The charge nurse responsible for the unit will label theout&de of the chart on weekends and holidays. 7. Individual measuring pitchers and glasses,
American
34A
APIC notes
INFECTION
collection jugs, and urometers will be used and labeled with the patient name for his/ her use only. Reusable items will be emptied and returned to Central Processing in the appropriate plastic isolation bag (not water-soluble bag). Disposable items will be double-bagged and discarded in the trash. 8. All collected urine will be discarded in the bedpan sanitizer. Procedure:
Noncatheterized
patients
Multiple antibiotic-resistant urinary tract infections in noncatheterized patients will be managed as follows: 1. The ICP will notify the unit that the patient has a multiple antibiotic-resistant isolate. 2. The nursing staff will initiate the following action with the DTO: Enter the statement “Contaminated Urine-Multiple AntibioticResistant Organism” in the patient care plans. 3. Handwashing before and after patient contact is mandatory. 4. To alert all other patient care personnel, the ICP will label the outside of the patient chart as “Contaminated Urine-Multiple Antibiotic-Resistant Organism.” The charge nurse responsible for the unit will label the outside of the chart on weekends and holidays. 5 When specific gravities are done, the patient will have an indivi&aI urometer labeled with the patient name for his/her use only. Zndividd bedpans and urinals will be used as necessary and labeled with the patient’s name, sanitized in the bedpan sanitizer after each use, and returned to the same patient. When items are reusable, they will be emp-
Journal
of
CONTROL
tied and returned to Central Processing in the appropriate plastic isolation bag (not water-soluble bag). Disposable items will be double-bagged and discarded in trash. 6. All collected urine will be discarded in the bedpan sanitizer. procedure:
Environmental
Safety
Office
1. A log book of patients with multiple antibiotic-resistant organisms will be maintained by the Infection Control Office. 2. ICPs will check daily with the microbiology laboratory to determine if multiple antibiotic-resistant isolates have been identified. 3. Multiple antibiotic-resistant organisms isolated from sites other than the urinary tract will be evaluated by the Infection Control Office regarding isolation and management of patient. 4. Questions concerning the procedure and support in implementing these procedures can be obtained from the ICP. 0 . . The system has been accepted by the staff and has been easy to implement and enforce. During 1980- 1981 only six new resistant P. aeruginosa isolates were identified with the source as the urinary tract. Each infection control department should consider the need to develop policies and procedures for handling resistant organisms and may find these guidelines helpful for this purpose. Betsy Palmer, R.N., M.S.N. infection Control Practitioner Department of Environmental Safety Duke University Medical Center Durham. North Carolina
11 Number
2
1983
At the end of my talk, I ask for questions. If there are none, or only a few, I ask if anyone is curious about anything on the list. I may ask a specific person to tell me what a word on the list means or what a certain topic has to do with infection control. These are some of the questions from the orientees. “Doesn’t ‘media’ refer to TV and radio?” “What is the difference between isolation and precautions?” ” Scabies! In the hospital?” I provide an answer sheet (Fig. 2) to anyone who wishes to have it.
The emergence of multiple antibiotic-resistant organisms within the hospital setting is becoming a major problem. The ICP has a major responsibility in preventing cross-contamination and nosocomial infections caused by multiple antibiotic-resistant organisms. In addition, it is important for the ICP to educate the staff regarding the ramifications of multiple antibiotic resistant organisms and related outbreaks. Over the past several years the Hospital Infection Control Committee in our hospital noticed an increase in the number of multiple antibiotic-resistant isolates reported from the microbiology laboratory. A highly resistant organism is defined as an isolate that is resistant to a majority of the aminoglycoside sensitivity discs, especially amikacin. The urinary tract was the predominant site of infection in these patients. A majority of these isolates were Pseudomonas aenrginosa. From 1978 through 1979 a total of 74 resistant P. aemginosa isolates were reported from the urinary tract. In addition, clustering of patients had been noted on several ward locations. Several of these patients continue to be infected when readmitted, thereby providing an additional reservoir for infectious agents. The following guidelines were developed for the prevention and control of resistant P. aeruginosa or other resistant isolates from the urinary tract.
In evaluating the puzzle’s usefulness, I find the time spent to be more relaxed than it was, and from what I am told by the orientees, it is a fun way to learn that infection control is not as intimidating as they had supposed. Barbam L. We&w, R&l., B.S. infection Control Survailiance Nurse Greenbrier Valley HbspEZal Ronceverte, West Virginia
Multiple antibiotic-resis,tant urinary tract infections in catheterized’ patients wifl be managed as foollows: 1. The ICI? will notify the unit~that the p&em has a rrezrltiple a~t~~Q~~~r~~~a~t i~&te. 2. The nursing staff will init e liamoperator ing action with the data te (DTO): Enter the statement “C~~~~~~~~ Urine-IbMtiple ~tib~ti~~~~~~~t Organisms” in the patient care plans. 3. Patient will be 2~ a room qhoqe no other patient h cwthete transfer is necessary, n~ing $ range the transfer via Bed Controli Bed Control will have a copy of this policy and ‘procedure . 4. Handwasbing before and after patient contact is mandatory. 5. Initially the Foley bag will be labeled “Contaminated Urine” by the ICP. The charge nurse will then be responsible for labeling each new bag. The charge ntrrse will also be responsible for the initial labeling of the bag on weekends and holidays. 6. To alert all other patient care personnel, the ICP will label the outside of the p;aitiortt chart “Contaminated Urine-Multiple Antibio$icResistant Organism.“ The charge nurse responsible for the unit will label theout&de of the chart on weekends and holidays. 7. Individual measuring pitchers and glasses,
American
34A
APIC notes
INFECTION
collection jugs, and urometers will be used and labeled with the patient name for his/ her use only. Reusable items will be emptied and returned to Central Processing in the appropriate plastic isolation bag (not water-soluble bag). Disposable items will be double-bagged and discarded in the trash. 8. All collected urine will be discarded in the bedpan sanitizer. Procedure:
Noncatheterized
patients
Multiple antibiotic-resistant urinary tract infections in noncatheterized patients will be managed as follows: 1. The ICP will notify the unit that the patient has a multiple antibiotic-resistant isolate. 2. The nursing staff will initiate the following action with the DTO: Enter the statement “Contaminated Urine-Multiple AntibioticResistant Organism” in the patient care plans. 3. Handwashing before and after patient contact is mandatory. 4. To alert all other patient care personnel, the ICP will label the outside of the patient chart as “Contaminated Urine-Multiple Antibiotic-Resistant Organism.” The charge nurse responsible for the unit will label the outside of the chart on weekends and holidays. 5 When specific gravities are done, the patient will have an indivi&aI urometer labeled with the patient name for his/her use only. Zndividd bedpans and urinals will be used as necessary and labeled with the patient’s name, sanitized in the bedpan sanitizer after each use, and returned to the same patient. When items are reusable, they will be emp-
Journal
of
CONTROL
tied and returned to Central Processing in the appropriate plastic isolation bag (not water-soluble bag). Disposable items will be double-bagged and discarded in trash. 6. All collected urine will be discarded in the bedpan sanitizer. procedure:
Environmental
Safety
Office
1. A log book of patients with multiple antibiotic-resistant organisms will be maintained by the Infection Control Office. 2. ICPs will check daily with the microbiology laboratory to determine if multiple antibiotic-resistant isolates have been identified. 3. Multiple antibiotic-resistant organisms isolated from sites other than the urinary tract will be evaluated by the Infection Control Office regarding isolation and management of patient. 4. Questions concerning the procedure and support in implementing these procedures can be obtained from the ICP. 0 . . The system has been accepted by the staff and has been easy to implement and enforce. During 1980- 1981 only six new resistant P. aeruginosa isolates were identified with the source as the urinary tract. Each infection control department should consider the need to develop policies and procedures for handling resistant organisms and may find these guidelines helpful for this purpose. Betsy Palmer, R.N., M.S.N. infection Control Practitioner Department of Environmental Safety Duke University Medical Center Durham. North Carolina