Extended spectrum beta lactamase (ESBL)

ESBLs are enzymes that may be produced by a particular type of germ (bacteria), usually found in the bowel (gut / intestines). Most of the time these germs do not cause problems (this is called colonisation). Occasionally it can cause serious infections of the bladder or kidney (urinary tract), blood or wounds.

ESBL bacteria are resistant to specific antibiotics (this means the antibiotics can no longer kill them). Because ESBL bacteria are resistant to a wider range of antibiotics they are more difficult to treat if you have an infection.

How are ESBL germs spread?

ESBL germs can be passed on in several different ways, including:

• Touching surfaces or objects that have been soiled with ESBL germs, and then putting your hand in your mouth
• Direct contact with a person with this germ (for example, when changing your child’s nappy).

Who is at an increased risk of becoming infected with ESBL germs?

In hospital the children who are at an increased risk of becoming infected with ESBL are children who:

• Have other health conditions that make them sick
• Have recently been cared for in a high risk setting such as an intensive care unit
• Have intravascular lines, indwelling urinary devices (catheters) or have had surgical procedures
• Have been treated with frequent or long-term antibiotics.

How can you prevent the spread of ESBL?

If your child is in Queensland Children’s Hospital with ESBL and you are staying with them, there are guidelines you can follow to minimise the risk of spreading the infection to yourself, members of your family and to other children in the hospital. These include:

• Washing your hands and your child’s hands frequently. Use an alcohol-based hand rub or wash your hands with soap and water, then dry them thoroughly. This is the most important thing you can do to prevent the spread of ESBL.
  It is particularly important that you and your child wash your hands after going to the toilet/changing nappies or touching areas where the ESBL-containing bacteria may be.

• Hospital staff may use special precautions to minimise risk of spreading ESBL to other patients, such as placing your child in a single room and using personal protective equipment such as gloves and gowns while caring for your child.
• Your child will be asked to stay in their room, unless they are receiving tests and treatment.

How is ESBL diagnosed?

A swab from your child’s bottom, or a sample of urine or sputum will be sent to a laboratory to check if ESBL germs remain present.

Your child may not have an ESBL “infection”. It may be that the bacteria are living in or on their body without causing any harm. This is called colonisation. In this case, they will not need to have the ESBL treated unless their doctor thinks it is needed.

Most children who are colonised with ESBL do not usually have to stay longer in hospital.

How is ESBL treated?

Your child may be treated with antibiotics that kill ESBL if they have either a local infection such as an infected wound, or if they have a more serious infection. They may have to stay in hospital until the infection shows signs of improving or has resolved.

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
• Before and after leaving your room
• 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)

It is very important that your health care workers 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?”

If my child has ESBL can they have visitors?

Your child can receive visitors from the school and entertainment services if they are not able to leave their room or attend these areas in person. These hospital visitors will use the required additional precautions (gown and gloves). It may be suitable for you and your child to leave the hospital to visit the South Bank precinct or other areas.

ESBL 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 your child. Visitors will be asked to wash their hands after visiting your child, so that they do not spread ESBL to others. You can also encourage visitors to wash their hands before and after visiting.

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

What happens when we visit the outpatients department or return to the hospital after discharge?

As there may be other children who are at high risk of infection, precautions will still be put in place when you visit outpatient clinics or day units, come to the emergency department or are re-admitted to hospital. This may involve using a single room or allocating a time slot for appointments or procedures when there are fewer patients. Please let staff know that ESBL precautions are required. The hospital patient information system (our database) should also have a record of the need for ESBL precautions.

Do I have to tell the school, pre-school / kindergarten, other parents, sports groups or camps?

No. The risk to others outside a hospital environment is very low. Other children may have ESBL but may not be aware of this. It can live in or on the body without causing any harm. Good hand cleaning is the most important factor in preventing spread.

Can ESBL be cleared?

Some children can be cleared of ESBL. This depends on the use of antibiotics, whether they have any drains / tubes or devices, and whether they have any ongoing health conditions. The infection control nurses will be able to advise you.

For more information

If you have any questions, please ask the infection control team or the healthcare worker caring for your child.

Patient information guides are also available from:

National Health and Medical Research CouncilAustralian Commission on Safety and Quality in Health Care

Contact us

Infection Management and Prevention Service Queensland Children’s Hospital
501 Stanley Street, South Brisbane 4101
e: CHQ_IMPS@health.qld.gov.au

In an emergency, always call 000.

If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week.