ESBL is the acronym for Extended Spectrum Beta Lactamase. If it sounds somewhat complicated it is; basically, ESBLs are bacteria that produce an enzyme capable of neutralizing the effectiveness of certain classes of Beta-lactam antibiotics such as, carbapenems, cephalosporins and certain penicillin derivatives. The end result is yet another type of Multi-drug resistant Organism (MDRO).
The bacteria are spread in the same way all organisms are transmitted depending on their site. Those at highest risk are usually hospitalized patients who have been on extensive antimicrobial therapy and have already compromised immune systems.
What should be done about ESBLs in long-term care? If you are new to infection prevention, be sure to locate your facility policy for MDROS in your Infection Control Manual. Hopefully, the policy will be up to date and based on the evidence based guidelines and recommendations available to long-term care facilities in your state. The CDC, your state Department of Public Health and APIC (Association for Professionals in Infection Control and Epidemiology) are theBig 3support systems for Infection Preventionists. Visit their websites frequently.
If you aren’t sure or have questions, seek out the support of your DON, and the Infection Control Committee. Together, you can review, update and sign off on a current policy. As soon as appropriate, announce the presence of an updated policy for MDROs (including ESBLS) to the staff and educate them to its definition, treatment and potential precautions.
Standard Precautionsare THE place to start; utilize Transmission Based Precautions for infections that cannot be contained. Think about that.
Is an ESBL in the urine contained in a Foley bag, a diaper or as a continent patient?
If the source of the organism is contained, the patient’s hands are clean, they are wearing clean clothes and want to socialize, could they be managed with Standard Precautions? What is the policy for your facility? Is your staff educated frequently to the principles of Standard Precautions?