Patient/staff handout for vancomycin resistance
July 1, 1998 4 minutes read
Patient/staff handout for vancomycin resistance
(Editor's note: An educational handout used at Lady of Lourdes Medical Center in Camden, NJ, is summarized below. The handout refers to vancomycin intermediate-resistant Staphylococcus aureus, but uses the acronym GISA for glycopeptide-intermediate S. aureus. The microorganisms are the same, but some clinicians are beginning to use the GISA name to avoid confusion with the credit card name.)
What is it?
Staphylococcus aureus is a bacteria sometimes found on skin and mucous membranes of humans. This organism is a frequent cause of infections among healthy individuals and has been found to be the most common cause of hospital-acquired infections. As a pathogen, S. aureus can cause pneumonia and skin and soft-tissue infections, and can be lethal if left untreated.
Over the past several decades, S. aureus has become increasingly resistant to antibiotics. Methicillin-resistant S. aureus (MRSA) has already been described and now identified with reduced susceptibility to vancomycin, a glycopeptide antibiotic (GISA).
Why the concern for GISA?
Normally, vancomycin is used as second-line therapy for treating systemic infections with multidrug-resistant gram-positive organisms. With GISA infections, there are very limited antibiotic therapies available for treatment of these resistant organisms.
Who is at risk for GISA?
Patients at most risk for acquiring GISA appear to be those severely ill and receiving prolonged antimicrobial therapy, particularly vancomycin.
How is it spread?
All staphylococcus organisms are easily spread by direct contact. It can spread to patients by health care workers' hands going from patient to patient or from one body site to another (i.e., wound site to respiratory tract) on the same patient.
What control measures do we have?
Patients identified with GISA are placed in Antibiotic Resistant Organism (ARO) Isolation and in a private room. A bright green ARO sign alerts all hospital staff and visitors to follow infection control protocols, including the following:
· Gloves must be worn to enter the room.
· Gown and mask if close contact with the patient is anticipated.
· Scrupulous hand washing with antimicrobial soap after removal of gloves/before leaving the patient room.
· Dedicated equipment for the patient - any equipment taken out of the room must be disinfected with a medical center-approved germicide or alcohol.
· Additional measures include limiting the number of health care workers and ancillary staff having contact with the patient.
In addition, health care workers may be cultured periodically to ensure the organism is not being transmitted. GISA surveillance cultures will be periodically taken from the patient to monitor for continued presence of the organism.
What happens to a patient with GISA upon discharge?
Nursing facilities receiving a patient with GISA must be fully informed of the patient's colonization/infection status so proper control measures can be instituted.
In preparing the patient for discharge to home, good hand washing and attention to personal hygiene practice must be emphasized. Home caregivers must also practice good hand-washing techniques. Clothing and bed linens are laundered in hot water wash cycle with detergent.
What are some tips for home care?
Caregiver(s) hand care instructions:
· Wash your hands for at least 10 seconds after close contact with a GISA-colonized or -infected patient or with any items the patient has touched, and before preparing any food and before eating.
· Use an antibacterial soap.
Eating
· If you prepare food, wash your hands thoroughly before doing so.
· Do not share dishes and utensils or have others take bites of your food.
· Wash your hands before eating.
· If you do not have a dishwasher, wash the dishes with dish soap and hot water.
Toileting/Grooming
· Wash hands thoroughly after toileting.
· Carefully dispose of dressings and other disposable materials that may be contaminated.
· Hands are washed after contact with any wound care area or other body fluids.
· Use an antibacterial soap.
Waste management
· Put all disposable wastes like dressings and bandages into plastic bags. Tie the bags securely. They can be thrown out with the regular trash.
Laundry
· Clothing, bed linen, and towels heavily soiled with body fluids should be washed by themselves in detergent and bleach.
· Articles NOT soiled with body fluids can be washed with the family's clothing.
Household cleaning
· You can use a solution of bleach and water to clean. Mix 1 part bleach to 10 parts water. You should make up a new batch each day. A commercial disinfectant cleaner is also appropriate.
· GISA is easy to kill on surfaces, as long as it is in contact with disinfectant cleaner. A wet surface allowed to air-dry will be sufficient contact time to kill the germ.
Physician office appointments and follow-up
· When you go to doctors' offices or to hospitals, you should tell the doctors and nurses that you have GISA prior to your appointment, so they can take steps to avoid spreading it to others.
· Your doctor may obtain surveillance cultures to see if the GISA organism still persists.
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