Discharge process keeps patients safe from superbugs

By Alicia Hall

An innovative new discharge process led by a multidisciplinary team at St. Joseph’s Health Centre is helping keep patients safer from becoming sick with super bugs. Carbapenemase-producing Enterobacteriaceae (CPE) are antibiotic-resistant bacteria that can spread from patient to patient in a hospital environment when appropriate precautions are not in place. Current guidelines recommend patients colonized or infected with CPE be placed in a private room on infection control precautions, and upon discharge, their rooms thoroughly cleaned to reduce the chance of CPE spreading to other patients.

“Our cleaning practices are rigorous when a patient known to be CPE positive has been discharged,” says Dr. Jennie Johnstone, Infection Control Officer, “but we recently realized that CPE is hiding in new places in hospitals across the country — sink drains (in patient rooms) seem to be an increasingly common mode of transmission for CPE because if contaminated fluids are dumped down the drain, they stay there where they can then be spread to others.”

“Once we discovered this, we immediately looked at two things: how we could limit the ways that sinks were becoming contaminated and, after knowing that a sink was contaminated, how we could clean it so that it was safe for patients to use again.”

We created a multidisciplinary team led by our Infection Control Practitioners who came up with several strategies to solve this issue, including: moving to waterless bathing for any patients known to be CPE positive to eliminate the need to dump any fluids down the drains; increased education about the importance of using sinks in patient rooms strictly for cleaning hands; and developing a discharge process checklist to be followed when a patient known to be CPE positive has been discharged from a room.

“The discharge checklist has been incredibly helpful and successful because it provides a step-by-step guideline of how to clean a room after a patient with CPE has been moved from it,” says Dr. Johnstone. “Everything has to be completed before we allow another patient to go into that room, preventing patients from acquiring CPE.”

The checklist – which includes shutting off the water to the sink, swabbing the sink to test for contamination, and cleaning it using a special disinfection process – has now been shared with hospitals across Canada. Our teams have presented at multiple conferences, and our Infection, Prevention and Control Team team routinely receives requests for the discharge checklist so that it can be adapted and implemented in other hospitals.

“This is just one of the ways we’re delivering high quality care to our community,” says Dr. Johnstone. “And by working with our partners and sharing our learnings and new process for standardizing the discharge process and room cleaning of patients who have CPE, we are helping other hospitals create a standardized approach to create a safe care environment for all patients.”

Alica Hall is a Communications Associate at St. Joseph’s Health Centre.