Session 3: Session 3: Measures for Colonized Residents
Resident:
What should we do if a resident carries multi-drug resistant organisms, such as VRE?
Host:
Preferably, the elderly home should arrange a single room for the colonised resident. Otherwise, at least arrange all residents carrying the same type of multi-drug resistant organism to live in the same room.
If the aforesaid arrangement is not feasible, they may separate the colonised resident from others with a screen. Never assign the colonised resident to live in the same room with the high risk groups, such as residents with indwelling catheters, like a nasogastric tube or urinary catheter, or those who cannot look after themselves or maintain personal hygiene.
The colonised residents should be identified for staff to differentiate, whilst respecting their privacy.
Host:
1 part of household bleach to 99 parts of water should be used to disinfect the environment at least three times a day.
Especially the frequently touched areas, such as door knobs, bedside tables and bedside rails.
Designate and clearly mark a special set of cleansing tools, such as mops, buckets and clothes.
And disinfect the tools after every use.
Host:
A special set of medical equipment should be provided for the colonised resident, such as blood pressure monitor cuff and thermometer.
Some facilities should also be provided exclusively for the resident if needed, such as commodes, bathrooms, toilets and wheelchairs.
Other residents should avoid sharing those facilities, especially those with indwelling catheters, damaged skin, such as pressure sores or exposed wounds.
If they have to share the facilities, the colonised resident should be the last one to use them, and the items should be disinfected every time after use.
Staff:
What else should we pay attention to?
Host:
You must first evaluate the conditions of the residents. Standard Precautions can be implemented for colonised residents who don’t display any symptoms or the colonised residents who are healthy and have better self-care abilities.
Standard Precautions include wearing gloves whenever contacting blood, body fluids, secretions, excreta, mucous membranes or wounds.
Should the blood or body fluids splash, remember to wear a mask, goggles or face shield and gown.
Do not recap used needle.
Used needles must be disposed in the sharps box immediately.
If you directly come into contact with any blood, body fluids, secretions, excreta, mucous membranes or wounds, you must perform hand hygiene immediately.
The colonised residents may socialise with the non-carriers, but residents must be reminded to maintain good personal hygiene, especially hand hygiene.
Host:
If the residents carry multi-drug resistant organisms like VRE or have high risk factors
Including: indwelling catheter,
damaged skin,
or exposed wounds,
or fail to maintain personal and environmental hygiene for personal reasons, the Modified Contact Precautions should be implemented on top of the Standard Precautions which have been mentioned.
Host:
The Modified Contact Precautions include the followings:
If you need to go into the colonised resident’s room and has to have contact with him or her or the surroundings that may be contaminated, you should use the appropriate protective equipment. For example, if you will have close contact with or support or carry the resident, such as changing diapers or bathing, you should put on a gown and gloves.
If there are splashes during the nursing procedures, then you need to wear a face shield or cap to protect your mouth, nose, eyes and hair.
Host:
The area for putting on the personal protective equipment should be located outside the isolation room or area with provision of alcohol-based handrub.
The area for removing personal protective equipment should be located within the isolation room or area with provision of alcohol-based handrub and a lidded rubbish bin.
The instructions for putting on and taking off personal protective equipment and a poster on hand hygiene can be affixed at a prominent place.