This annex is added as an extension to PIDAC’s Routine Practices and Additional Precautions and deals specifically with the screening, laboratory testing and surveillance of antibiotic-resistant organisms (AROs), such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-intermediate Staphylococcus aureus (VISA), vancomycin-resistant Staphylococcus aureus (VRSA), vancomycin-resistant enterococci (VRE) and resistant Gram-negative bacilli, such as extended- spectrum beta-lactamase (ESBL)-producing bacteria, in health care settings across the continuum of care including, but not limited to acute care, long-term care, chronic (including mental health) care and home health care.
The infection prevention and control management of health care-associated MRSA and community-associated MRSA is the same and is detailed in ‘Routine Practices and Additional Precautions.’
In July 2011, the Provincial Infectious Diseases Advisory Committee on Infection Prevention and Control (PIDAC-IPC) revised the Best Practice Manual: Routine Practices and Additional Precautions and Annex A: Screening, Testing and Surveillance for Antibiotic-Resistant Organisms to provide better guidance to health care providers on the management of carbapenem-resistant Enterobacteriaceae (CRE) in health care settings.
Increasingly identified as a significant factor in the transmission of antibiotic resistant organisms (AROs), CREs have been associated with increased morbidity and mortality in patient populations. The revisions address indications for screening patients for CRE, specimens to be obtained, and the management of patients identified as a significant need.
NEW (November 2011): Since the writing of the second revision in July 2011, PIDAC-IPC has identified the need for further, more specific screening recommendations for the detection, prevention and control of CRE in Ontario. In the third revision of this document, the committee is recommending enhanced guidelines for the screening of patients and residents for CRE, adding a degree of precision to the recommendations for screening among contacts of cases and the infection prevention and control requirements to address CRE.
In February 2012, Annex A was updated to include a revised Appendix B, “Sample Risk Factor-Based Admission Form for Screening for MRSA, VRE, ESBL and CRE” to incorporate ESBL and CRE.
Page 21, under
“What are ESBLs?”, first sentence should read: “Beta-lactamase (ß-lactamase) is an enzyme produced by some bacteria that inactivates the ß-lactam class of antibiotics (e.g., penicillins, cephalosporins).” [CORRECTION: Deleted “carbapenems”]
Note: See PIDAC’s Best Practices for Surveillance of Health Care-Associated Infections in Patient and Resident Populations for information regarding surveillance methodology and interpretation of data.
Click below to download Annex A: Screening, Testing and Surveillance for Antibiotic-Resistant Organisms (AROs) in all health care settings (84 pages, PDF, 2.4 MB).
English (82 pages, 2.4 MB) (NEW)
Correction Notice: “CRE” now replaces “ESBL-producing bacteria” in # 3 in the CRE Staff Fact Sheet found on page 47.
French (91 pages, 2.6 MB) (NEW)
Avis de correction: “L’ERC” remplace actuellement “les bactéries productrices de BLSE” du numéro trois qui se trouve sur la page 57 dans le Feuillet d’information à l’intention du personnel d’ERC.