Residents colonised or infected with ESBLs who have risk factors for transmission, or whose basic personal hygiene practices may be compromised by cognitive or functional impairment, are more likely to contaminate their environment. It is essential that residential care facilities engage with their infection prevention and control lead, to ensure appropriate management occurs.

ESBLs are spread in a similar way to other MRO/MDROs

Ensure a risk assessment is performed prior to bed allocation and/or at admission

Contact precautions will be required for those residents with risk factors for transmission

Strict adherence to hand hygiene protocols must be followed

Keep the environment clean and dust-free at all times, and use a 2-step cleaning regimen if the resident is cared for under contact precautions

Hand Hygiene

Proper hand hygiene is essential, and if the resident's cognitive state is impaired, employees caring for them must be responsible for this activity, especially after any toileting or contact with colonised/infected sites or devices.

Strict adherence to standard precautions is the recommended safe practice for all resident contact regardless of whether or not infection is present. 

Effective hand hygiene is the single most important means of preventing spread of ESBLs. 

Hand hygiene should be performed

When entering, or leaving the room

Before and after dressings are attended

Before and after wearing gloves

The use of gloves does not replace the need for hand decontamination. Hand hygiene should be performed before and after glove use. 

Plain liquid soap is adequate for hand washing and an antimicrobial handwash may be used before and after dressing wounds or if the resident is incontinent or has diarrhoea.

In the absence of sufficient or adequate hand washing facilities, and where hands are not visibly contaminated, an alcohol based hand rub/sanitiser should be used for hand cleansing.

Placement of residents with ESBLS

A single room, preferably with its own bathroom (first preference)

Room sharing or cohorting of residents infected or colonised with ESBLs (second preference)

Room or ward sharing with non-infected or non-colonised resident(s) with no indwelling devices or wounds (third preference)

The priority for a single room or choice of roommate(s) is determined by a risk assessment of the resident population taking into consideration

Likelihood of ESBL transmission from the source resident

Risk and consequences of the non-infected or colonised co-resident(s) becoming colonised or infected

The setting in which care is provided

Maintain appropriate employee levels to provide adequate resident care for whatever means of placement is chosen

Use of personal protective equipment

Wear clean, non-sterile gloves when touching the resident or a potentially contaminated environmental source, including when touching body substances, wound sites or faeces

Change gloves between residents

Change gloves between tasks on the same resident

Perform hand hygiene after removing gloves

Use impervious gowns or waterproof aprons to protect the skin or clothing from gross contamination

Shoe covers and hair covers are not recommended

Where resources for physical barriers are limited, establish glove use as the priority

Consideration should be given to balancing the infection risks to other residents and the presence of risk factors that increase the likelihood of infection transmission, with the potential adverse psychological impact on the infected or colonised resident.

The need for the continuation of spatial separation or physical barriers should be reassessed periodically. Discontinue additional precautions as soon as feasible. Determinants for discontinuation must be individualised.

The ESBL-positive resident with risk factors for transmission may attend community activities provided that any colonised/infected site or invasive device can be securely covered (e.g. chronic wound, tracheostomy tube, urinary catheter), and that there is no leakage of any body fluids/secretions/excretions.