Extended Spectrum Beta Lactamase (ESBL)

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What are ESBL Producing Bacteria?

They are Gram-negative bacteria that produce an enzyme, beta-lactamaze that can break down commonly used antibiotics, such as penicillin and cephalosporins, making infections with ESBL producing bacteria more difficult to treat. Enterobacteriaceae E.coli and Klebsiella pneumoniae are common producers of ESBL, and they usually cause urinary tract infections and bacteraemia.

People who carry ESBL producing bacteria without any sign or symptom of infection are “colonized”.

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Risk Factors for ESBL:

  • Extensive treatment with antibiotics
  • Prolonged stay in a health care institution, particularly in an ICU
  • Severity of illness: neutropaenia, organ transplant, haemodialysis or tube feeding
  • Indwelling catheters
  • Communal living setting

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How are ESBLs Spread?

The main reservoir is the lower bowel of colonized or infected persons. Common ways of transmission is through unwashed hands.

ESBL producing bacteria can survive on surfaces without a major role in transmission, if good hand washing and infection control measures are practiced.

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Surveillance and Screening for ESBL:

  • Routine screening of residents in a LTCH is based on the burden of ESBL and the policy of the home, as directed by Infection Prevention and Control.
  • Routine screening of staff for ESBL is not recommended.
  • In an outbreak with ESBL producing bacteria screening should follow a protocol to actively identify new cases.

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Decolonization

ESBL decolonization is not effective and not recommended.

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Specimens for Laboratory Testing

The preferred specimen for ESBL screening is a rectal swab or stool. Stool specimens have a higher yield. A urine culture may also be sent in certain circumstances such as the presence of catheters.

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Prevention and Control of ESBL

In general, use routine practices and contact precautions (gloves and gown) when providing direct resident care.

  • Accommodation in single room with own toileting
  • Good hand washing and four moments of hand hygiene
    1. Before resident or resident environment contact
    2. Before performing aseptic procedure
    3. After care involving body fluids
    4. After resident or resident environment contact
  • Provide help to residents with their hand hygiene practices
  • Routine environmental cleaning
  • Use dedicated personal care equipment whenever possible and thoroughly clean and disinfect shared equipment
  • Personal Protective Equipment
  • Use gloves and long sleeve gown while providing direct resident care and cleaning resident’s environment
  • Routine cleaning of the environment, laundry and dishwashing

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Family and Visitors Considerations

  • Educate all visitors, including family members to practice good hand hygiene before and after leaving the resident’s room
  • Family members providing direct personal care wear the same PPE-gloves and gowns
  • Feeding and pushing a wheelchair is not direct care, but hand hygiene is necessary

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Discontinuation of Contact Precautions

Review at least three negative laboratory test results from all colonized or infected body sites, with specimens collected at least one week apart, in the absence of antibiotic therapy with Infection Control.

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Refer to Annex A: Screening, Testing and Surveillance for Antibiotic-resistant Organisms (AROs)/ PIDAC, February 2012.