In this guidance section 4.8 highlight how to minimise transmission in non-acute care settings. This information can be found below for ease:
4.8 Non-acute care settings
Non-acute settings should not refuse admission or readmission of service users on the grounds that they are colonised with CPE. Furthermore, discharge should not be delayed until an infection has resolved if the patient is well enough to be discharged. Good communication will prevent unnecessary anxiety, misunderstanding or confusion
for the family or healthcare facility receiving the patient.
In a shared care environment, a CPE carrier who is not at high risk of spreading CPE to others does not need to be isolated and should be allowed to use communal facilities. If possible, the individual should be accommodated in a single room with en-suite facilities. If not possible, they should not share a room with an immunocompromised individual or those with other risk factors such as chronic wounds.
Those at high risk of infecting others for example with uncontrolled faecal incontinence should have their care activities undertaken in a single room with en-suite facilities. If an en-suite room is not available, the individual should be placed in a single room with a designated commode with easy access to hand washing facilities.
Where rehabilitation is needed, and faecal incontinence is unable to be resolved for example due to an underlying bowel condition or a long-term discharging anal rectal
wound, an individual risk assessment can be undertaken with the support of the IPC team, which should include the:
• ability to perform hand hygiene, before, after and during the activity
• frequency of loose stools
• ability to contain the faecal incontinence and wound discharge
• environment within which the rehabilitation is being undertaken such as, surfaces
that are easy to clean
• resident’s compliance with IPC precautions
• type of activity being undertaken for example heavy exercise with likely sweat
• equipment being used – can it be easily cleaned?
• susceptibility to infection of other participants – where possible rehabilitation activities should be undertaken on an individual basis rather than group activities
See Appendix C for further information on how to conduct a CPE risk assessment in non-acute settings. In outpatient and ambulatory care settings, faecally continent patients with CPE who have no other risk factors present a very low risk of transmission and therefore isolation or cohorting are not routinely required. In contrast, CPE colonised patients with diarrhoea pose a greater risk of transmission; environmental and
equipment decontamination will be required following their visit.
Determining if someone is a high risk of infecting others is based on a risk assessment. The local Health Protection Team can provide advice on this, or Community Infection Prevention
and Control specialists if available.