Interim Measures to Prevent and Control Transmission of Carbapenemase-producing Enterobacteriaceae and other Multidrug-Resistant Gram-Negative Bacilli in Long-term Care Settings
In 2010, the Comité sur les infections nosocomiales du Québec (CINQ) [Québec healthcare-associated infections committee] released its guidelines for preventing and controlling transmission of carbapenemase-producing Enterobacteriaceae, and then more recently, in 2015, its measures to prevent and control transmission of multidrug-resistant Gram-negative bacilli (MDR-GNB) in acute care settings.
The application of infection prevention and control (IPC) measures in long-term care settings (CHSLDs) must be adapted to the characteristics specific to these settings, as well as to the clientele residing in these settings. The purpose of this document is to provide IPC staff working in CHSLDs and the clinicians who practice there with up-to-date information that applies to these specific settings.
Persons who reside in long-term care facilities not only live there, but also receive healthcare services there. Even though this type of accommodation is increasingly restricted to persons with complex pathologies or major motor, sensory or cognitive dysfunctions, such accommodation must remain a pleasant and friendly place of residence. Therefore, the interventions differ from those usually carried out in care settings. The level of care provided usually differs from that provided in acute care settings and there is a lower proportion of at-risk persons. The long length of time the residents stay in such centres (often several years) limits, among other things, the long-term application of restrictive measures. It is also important to consider the impact that implementing additional precautions during care can have on a resident.
Regarding IPC measures to be taken at a CHSLD, the focus is to prevent the transmission of cases of carbapenemase-producing Enterobacteriaceae (CPE) within these settings so that they do not become a reservoir and increase the risk of transmission to short-term care facilities when the residents are transferred.
Since there is a limited amount of up-to-date epidemiological information documenting the potential for transmission of CPE in CHSLDs, the IPC measures recommended take into consideration the information in the literature on transmission of MDR-GNB.
These studies have clearly demonstrated that residents admitted to long-term care are potential reservoirs for MDR-GNB. Carriers can be the source of subsequent transmission when they are transferred to short-term care facilities if measures have not been taken. Some risk factors for developing infections among CHSLD clientele have also been identified, including invasive devices (urinary catheter, vascular catheter, gastrostomy, tracheostomy), wounds and a resident having recently taken, or still taking, antibiotics. The measures recommended take into consideration the intensity of the care provided to residents in the various types of long-term care centres. Besides accommodation, long-term care facilities may offer other types of services or care for certain beds or units, for example, transition beds or units, functional rehabilitation units (FRU) or short-term geriatric units (STGU), which is why it is so important to adapt the measures to meet the risk assessment (e.g. risk of environmental contamination or of developing an infection). Lastly, the measures recommended in this document may be adapted to reflect new epidemiological information.