Handling Patients With Antimicrobial-Resistant Infections

Communication needed

The Clinical Microbiology Laboratory Supervisor will communicate the presence of an animal with an antimicrobial resistant infection to the Clinical Microbiologist, Clinical Pharmacologist, area supervisor of patients. Monthly summaries of antimicrobial resistant infections should be provided by the Clinical Microbiologist to the VH Infectious Disease Control Committee.

  • The supervisor of the clinical area will flag the patient's cage with the following yellow label:

Patient Has An Antibiotic Resistant Infection. Contact Student Or Nurse In Charge Before

  • A dated, yellow label will be placed on the cover of the permanent record by the service.
  • Removal of Yellow label:
    • The yellow label may be removed if any of the following criteria are met:

 If, in the judgment of the clinician responsible for the case, there is resolution of
 the patient’s infection based on clinical examination, laboratory data (when
 appropriate) and history.

    • A negative culture is obtained from the site of the original infection, or the cultured isolate is no longer a resistant strain.
  • The infected tissue has been removed and the site is healed.
  • If the yellow label is removed, clinicians must note this in the medical record.

Patient Handling and Housing

  • Persons in contact with patients with an antimicrobial resistant infection shall wear examination gloves when handling the patient or materials that have been in contact with the patient.
  • Hands should be thoroughly washed immediately after handling the animal and after glove removal.
  • The patient will be removed from its cage only when necessary.
  • If the patient's cage/stall requires frequent cleaning, additional cages should be assigned for exclusive use by the patient.
  • When the patient is discharged or moved to another area of the hospital, the supervisor of that clinical area shall be notified so that the cage and cart (if used) can be properly cleaned and disinfected.
  • Animal technicians are to use an appropriate disinfectant G01 and cleaning equipment (bucket/mop) that is assigned to this patient when cleaning the cage. To reduce contamination, the cleaning equipment must not be used to clean other areas.

Patient Transportation Within Hospital

  • If the patient must be transported within the clinic for special procedures, only one gurney shall be used by the patient from the time it leaves the cage/run until returning to the cage/run. No other animals, hospital supplies or equipment should be placed on the gurney. The yellow antimicrobial resistant pathogen label (described above) should be placed on the gurney.
  • Patients housed in the service specific areas should exit to the exercise yard through the hallway exit. Patients housed in General Hospital, IMC or ICU should use the exits specified for their areas.
  • The student, technician, or clinician in charge of the patient shall remain with the patient until it is returned to the original cage/run.
  • When in another area of the hospital, the patient shall be kept isolated from other patients, and
    • Should not placed in holding cages.
    • The nurse and nursing supervisor responsible for areas where the patient has been treated shall be informed immediately so that the area can be properly disinfected with the appropriate disinfectant G01 solution.

Patient Treatments

  • Before initiating a treatment, ensure that all items necessary to perform the treatment have been gathered to prevent spreading contamination during the treatment.
  • If there is more than one patient to be treated at a time, whenever possible, treat the patient with the resistant infection last.
  • Whenever possible, use disposable materials. Items that are not disposable shall bethoroughly disinfected immediately after use.
  • Disposable items should be immediately placed in a biohazard bag. They should not be placed on counters, exam tables or other surfaces.

Handing Urine

  • Gloves should be worn when handling urine and urine collection materials.
  • Patients with urinary tract infections must be kept separate from other animals when they are urinating.
  • Catheterized patients should have a closed collection system.
  • Urine in cages and on floors shall be cleaned up promptly.
  • Gloves should also be worn when handling contaminated paper towels or other materials that have become potentially contaminated.
  • Gloves, paper towels used for cleaning, etc. shall be disposed of in a biohazard bag and placed in trash for incineration.

Cage and Kennel Cleaning

  • When the patient is discharged or moved to another area of the hospital, the supervisor ofthat clinical area shall be notified so that the cage can be properly disinfected.
  • After discharge the kennel staff will be responsible for ensuring the cage has been appropriately disinfected with an accelerated hydrogen peroxide disinfectant.
  • A note should be placed on the cage indicating that cleaning is pending.
  • Kennel technicians are to use cleaning equipment that is assigned to the patient when cleaning the cage.
  • To reduce contamination, the cleaning equipment shall not be used to clean any other areas and will be thoroughly disinfected using appropriate disinfection protocols before returning to circulation.
  • The cage will remain out of use until it is released for use by the kennel staff or the nursing supervisor responsible for that area.