Carbapenam resistant pseudonomas

Pseudomonas aeruginosa (pseudomonas) is a bacteria commonly found in water and soil, and only causes an illness when someone’s immune system is not working as well as it should. Healthy people often carry this bacteria around without it making them sick.

Pseudomonas can cause simple infections like ‘swimmers ear’ or ‘hot tub rash’. However, if someone in hospital who is ill gets infected with carbapenem resistant pseudomonas (CRP) they can become very unwell and require lengthy hospital stays.

Carbapenem resistant pseudomonas (CRP) occurs when the infection can’t be treated with antibiotics containing carbapenem. If this occurs, your doctor will need to prescribe your child a different type of antibiotic.

Who is at an increased risk of getting a CRP infection?

People who have impaired immune systems are at an increased risk of getting a CRP infection. These include patients:

• undergoing treatment for burns, cancer, cystic fibrosis, AIDS and HIV
• undergoing surgery
• in intensive care
• with temporary tubes in their body such as catheters or chest drains.

How is CRP spread?

In hospitals, CRP is often passed from child to child:

• via the hands of healthcare workers and caregivers
• through contact with contaminated equipment such as bed and cot rails, medical equipment, door handles
  and bathroom fixtures
• through the air by coughing or sneezing.

Why is it important to identify CRP?

CRP can cause infections in:

• blood: bacteraemia
• lungs: pneumonia
• skin: folliculitis
• ear: ‘swimmers ear’ or an infection in the ear canal
• eyes: conjunctivitis
• bones and joints: osteomyelitis.

Infections caused by CRP are uncommon and difficult to treat.

How is it diagnosed?

CRP can be detected from wound swabs, or through urine, faeces, blood, sputum and tissue samples.

How is it treated?

You or your child will not need treatment if you are carriers of CRP. However, make sure you advise health care workers if your child needs treatment or is being admitted to hospital.

Most CRP infections can be treated with antibiotics other than carbapenem. Laboratory testing can determine which antibiotics will work.

What can you do to help prevent the spread of CRP?

While your child is in hospital, it is important that you, your child, hospital staff and visitors use excellent hand hygiene practices. This means using an alcohol-based hand rub or washing with soap/antiseptic and water to clean your hands. This needs to be completed frequently and thoroughly to reduce the risk of spreading the bacteria. It is particularly important that you and your child perform hand hygiene after going to the toilet/changing nappies.

Your health care workers also need to clean their hands with alcohol-based hand rub or soap/antiseptic and water before and after providing care for your child. If you don’t see them cleaning their hands it’s OK to ask “have you cleaned your hands”. This is an important step in preventing the spread of CRP and other antibiotic-resistant germs.

When should you clean your hands?

You and your child should always clean hands:

• before handling anything that goes in your mouth or their mouth
• before preparing or eating food or drinks
• after going to the toilet
• after using a tissue or handkerchief
• after handling rubbish
• after handling dirty washing
• after coming into contact with an affected area (avoid touching wherever possible)
• before leaving the patient’s room.

What other precautions are taken?

Special precautions to minimise risk of spreading CRP to other children in the hospital will be used, such as placing your child in a single room and using personal protective equipment such as gloves, gowns and mask while caring for your child. Your child will also be asked to stay in their room, unless they are receiving tests and treatment. However, they can receive visitors from the school and entertainment services if they are not able to leave their room.

Our staff will also advise if it OK for your child to go for a walk outside the hospital.

If your child has CRP can they have visitors?

CRP can affect people who have certain long-term health problems. Please let the nursing staff know if someone who has a long-term health problem wants to visit you. They will need to be advised of the importance of hand hygiene to protect themselves and they may wish to discuss any risk to themselves with their treating doctor. Your visitors will be asked to wash their hands after visiting your child, so that they do not spread the bacteria other people. You should also encourage visitors to wash their hands before and after visiting you.

You and your visitors won’t usually need to wear gloves or gowns unless you or they will be visiting others in the hospital.

What happens when you visit the hospital outpatient department or return to the hospital after discharge?

As there may be other children who are at high risk of infection, precautions need to be put in place when you visit day units, come to the emergency department or are re-admitted to hospital. Please let staff know that CRP precautions are required. The hospital patient information system should also have a record of the need for CRP precautions. Precautions are not usually required when you visit outpatient clinics.

Do I have to tell my child’s school, pre-school, kindergarten or other parents?

No. The risk to others outside a hospital environment is very low. Regular hand washing is the most important factor in preventing spread of CRP. However, if your child has long-term treatment (e.g. cancer, haemodialysis,) there may be some restrictions on camps or gatherings with other children with the same illness. Please speak to our staff about this.

Can the CRP be cleared?

Some children can be cleared of CRP. Often this depends on the use of antibiotics and whether your child has any drains or devices needed for treatment. Ongoing /chronic health conditions also impact on the ability to clear CRP. Your health care team should contact the infection control team for advice.

Where can you find out more information?

For more information, please speak to the infection control team or the healthcare worker looking after you or your family.

When to seek help

See your GP if your child has any common symptoms.

In an emergency, call Triple Zero (000) and ask for an ambulance.

If you're not sure whether to go to an emergency department, call 13 HEALTH (13 43 25 84) and speak to a registered nurse.

Developed by the Infection Management and Prevention Service, Queensland Children’s Hospital. We acknowledge the input of consumers and carers.

Resource ID: FS175. Reviewed: February 2017.

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.