• Discuss with infection prevention team
• Strict contact isolation in single room with en-suite
• use gowns and gloves

Patient has clinical signs of Infection

• Check previous microbiology reports
• Discuss any empirical antibiotic treatment with microbiologist

Screen again

CARB isolated during current admission

• Do NOT send any (repeat) screening for MGNB during current admission
• Continue to isolate in single room with strict contact precautions

CARB isolated/detected prior to admission only, or ESBL/MGNB isolated prior or during current admission

• Take follow-up rectal or faeces swabs for ESBL/MGNB at least 1 day apart
• Send rectal/faeces swab, and swab from any other site originally positive
  • rectal swab must show visible faecal material for a reliable negative screening result
  • if no visible faecal material and/or the result of the screening is reported as “Invalid”, collect a stool sample and send a swab of the stool sample (= faeces swab) with visible faecal material
  • if catheter still in situ, send CSU for MGNB screening
  • if a productive cough present, sputum

History of carbapenemase-producing Acinetobacter (also known as MDRAB = Multi-Drug Resistant Acinetobacter baumanii)

• Add swab from any wound, chronic ulcer or skin lesion, tracheostomy site
• request ‘screen for carbapenemase-producing Acinetobacter’

Outcome of screens

• Once CPE/CARB has been reported, isolate patient for the entire duration of hospital stay irrespective of subsequent negative screens
• Before taking a patient with a CARB alert out of isolation, contact infection prevention team (IPT)

Patient transfer

• Before moving patient to any other ward, contact infection prevention team (IPT)

• Discuss with infection prevention team
• Undertake Standard infection prevention precautions
• Nurse patient in single room, or, if several patients infected/colonised, cohort in single bay
• If urinary catheter in situ, remove if possible
• if catheter needed, use silver-coated catheter
• If surgical antimicrobial prophylaxis required, see relevant guideline in Surgical guidelines

Patient has clinical signs of Infection

• Check previous microbiology results
• Discuss any empirical antibiotic treatment with microbiologist, especially in case of suspected life-threatening infection such as sepsis or pneumonia

48 hr after antimicrobial treatment has stopped

• Send CSU and rectal swab to laboratory
• if stoma or unable to obtain rectal swab, stool sample with reason stated

Keep screening long term admissions

• Take swabs for ESBL/MGNB at least 1 day apart
• send rectal swabs, swab from site originally positive and if catheter still in situ, CSU

Outcome of screening following ESBL/MGNB

3 consecutive sets of negative screens

• Check screens taken at least 1 day apart with at least one >48 hr after completion of any antimicrobial treatment
• If CARB organism reported during current admission, keep in strict contact isolation irrespective of negative screening results, and do not re-screen during current admission
• Only if no CARB organism has been reported during the current admission, patients may be moved from side room or cohort bay

Any of 3 consecutive weekly screens positive

• Keep patients in side-room or cohort
• do not send further samples for MGNB/ESBL screening