Extended Spectrum Beta Lactamase (ESBL)-producing bacteria are Gram-negative bacteria that produce an enzyme (beta-lactamaze) that can break down commonly-used antibiotics, such as penicillin and cephalosporins. This makes it more difficult to treat infections with ESBL-producing bacteria. Enterobacteriaceae E.coli and Klebsiella pneumoniae are common producers of ESBL, and usually cause urinary tract infections and bacteraemia.
People who carry ESBL producing bacteria but do not have any signs or symptoms of infection are “colonized.”
Risk factors
Risk factors for ESBL include:
- extensive treatment with antibiotics
- prolonged stay in a healthcare institution, particularly in an ICU
- severity of illness: neutropaenia, organ transplant, haemodialysis or tube feeding
- indwelling catheters
- communal living setting
How ESBLs spread
The main reservoir of ESBL-producing bacteria is the lower bowel of colonized or infected persons. The most common way to transmit ESBLs is through contact with 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.
Surveillance and screening
Routine screening of residents in a long-term care home is based on the burden of ESBL and the home's policy, 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.
Decolonization
ESBL decolonization is not effective and not recommended.
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 some circumstances, such as the presence of catheters.
Prevention and control
In general, use routine practices and contact precautions (gloves and gown) when providing direct resident care:
- Ensure accommodation in single room with own toileting.
- Follow good hand washing and four moments of hand hygiene:
- Before resident or resident environment contact
- Before performing aseptic procedure
- After care involving body fluids
- After resident or resident environment contact
- Help residents with their hand hygiene practices.
- Engage in routine environmental cleaning.
- Use dedicated personal care equipment whenever possible and thoroughly clean and disinfect shared equipment.
- Wear personal protective equipment (PPE). Use gloves and long sleeve gown while providing direct resident care and cleaning resident’s environment.
- Do routine cleaning of the environment, laundry and dishwashing.
Family and visitor considerations
Educate all visitors, including family members, to practice good hand hygiene before and after leaving the resident’s room. Family members who provide direct personal care should wear the same PPE (gloves and gowns).
Feeding and pushing a wheelchair is not direct care, but hand hygiene is necessary.
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.