Improving the patient journey through a risk assessment approach for ESBL-E
AbstractThe increase in multidrug resistant organisms (MDRO), including Extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E), presents a challenge for infection prevention and control (IPC) teams to find adequate isolation facilities. Not all ESBL-E positive patients may present a risk for ongoing transmission and require isolation. Reducing unnecessary isolation can help with patient flow and reduce adverse events associated with isolation precautions. The Canterbury District Health Board IPC team aimed to improve the bed management and patient journey for ESBL-E colonised/infected patients through the introduction of a risk-assessment approach for deciding the IPC and isolation requirements for these patients. Hospital policy and procedures were revised to include a process for categorising patients according to their individual risk factors for transmission of ESBL-E. Each category requires a specific set of IPC measures. To facilitate the new policy, a colour assessment tool in the form of a poster was developed as a quick reference for staff. The new policy and poster were introduced across all hospital sites over several months. Several single rooms a day were freed up which facilitated overall bed management and patient flow. Patients with a low risk of transmission of ESBL-E benefited from a potential better journey of care. Furthermore, IPC surveillance reports did not demonstrate any increase in nosocomial ESBL-E cases. Implementing a risk assessment for the placement and care of ESBL-E patients can have a positive outcome for patients, families, staff and bed managers, while mitigating the risk of transmission of antimicrobial resistance.
Copyright conditions: Copyright on any research article in the International Journal of Infection Control (IJIC) is retained by the author(s). Authors grant IJIC permission to publish the article and identify itself as the original publisher. Authors also grant any third party the right to use the article freely as long as its integrity is maintained and its original authors, citation details and publisher are identified. IJIC conforms to the Creative Commons Attribution License (http://creativecommons.org) as terms and conditions of publishing research articles. In summary, anyone is free: • to copy, distribute, and display the work; • to make derivative works; • to make commercial use of the work; as long as: • the original author must be given credit; • for any reuse or distribution, it must be made clear to others what the license terms of this work are; • any of these conditions can be waived if the authors gives permission. Statutory fair use and other rights are in no way affected by the above. Authors' certification: In submitting a manuscript to IJIC, authors are requested to certify that: • They are authorized by their co-authors to enter into these arrangements. • They warrant, on behalf of themselves and their co-authors, that: o the article is original, has not been formally published in any other peer-reviewed journal, is not under consideration by any other journal and does not infringe any existing copyright or any other third party rights; o they are the sole author(s) of the article and have full authority to enter into this agreement and in granting rights to IJIC are not in breach of any other obligation. If the law requires that the article be published in the public domain, they will notify IJIC at the time of submission; o the article contains nothing that is unlawful, libellous, or which would, if published, constitute a breach of contract or of confidence or of commitment given to secrecy; o they have taken due care to ensure the integrity of the article.