Episode Transcript
Infection Control Explained (ICE) Podcast 8
This Podcast is brought to you by the GOSH Learning Academy.
[00:00:04] Kate H: Welcome back to the ICE Podcast. ICE stands for Infection Control explained, and today we are going to be talking about Gram-negative resistant bugs or organisms. My name is Kate Harkus. I'm the lead practice educator for infection prevention and Control. And I'd like to say welcome back to Elaine Cloutman-Green, who has featured in two other podcasts in our series.
She is first and foremost a scientist. She is our infection control doctor and the deputy director of infection control at GOSH. Welcome back.
So Elaine, if you're happy to dive straight in and tell us a little bit about what Gram-negative organisms or bugs are.
[00:00:49] Elaine: I have to apologise for wax because I love a little bit of Gram-negative bacteria. They're super clever. They're my favorites and I'm gonna try to tell you why. Even the name's a bit confusing, right? When we talk about Gram-negative bacteria, most people will be like what the hell is that?
Whereas when we've talked about, so we did the episode on Vancomycin Resistant Enterococci. You've had an episode about MRSA, that's a single species of bug in the same way that humans are a species. They are a single species of bug. When we talk about gGam-negative bacteria, we are talking about a huge group of different species.
So it's the same as almost talking about mammals, right? So you've got mammals that live on land. You've got mammals that live in the ocean, you've got mammals that kind of have wings actually, so they can live in all kinds of different places. And so that's why it's a bit harder to talk about and explain what a Gram negative is, because actually we are then talking about a whole cluster of different bugs that are linked in the same way that mammals are linked.
In the fact that they share characteristics, but they're not all the same. Okay. So that's why they are sometimes a little bit more confusing to talk about. And the reason we call them Gram negative is there is an amazing man called Gram who, basically the main thing we do in the lab in micro is that we dye things.
So we dye bugs on glass slides under the microscope and you'll probably have seen it on TV and some bacteria stain pink and some bacteria stain purple. And so the pink ones are the Gram negative ones. 'cause they all have a similar cell wall. So rather than listing huge numbers of different bacteria, we just say Gram-negative for anything that looks pink when we look at it under the microscope and those bacteria share some characteristics. So in the same way that things like MRSA tend to live on your skin and they tend to like a bit of oxygen, so they sit on your hairline or just up the top of your nose a little bit in your throat your Gram negatives tend to like slightly less oxygen rich environments, so they'll be in your guts.
So when we talk about like good bacteria in terms of the stuff on like TV and adverts, some of those will be your Gram-negative bacteria that live in your gut. And the ones that we look at for this, when we talk about Gentamycin or Antibiotic resistant Gram negative bacteria. So we're talking about the ones that happen to live in your gut mostly, that happen to be a bit more resistant to antibiotics than the rest of them that live in the gut.
And so that's the context that we are talking about here. They're not necessarily doing you any harm. They're living there as part of your standard kind of gut bugs that you need actually to survive. We all have them, but some of them, especially if you've spent a lot of time in hospital or you've had a lot of antibiotics, may be more likely to be resistant than others.
And so that's what we then have to try and manage when you're in hospital in order to keep you safe.
[00:04:11] Kate H: I totally understand. I think the explaining it like, with mammals is actually really useful. So I guess then another question. If there was a patient being admitted, so it could be my child being admitted or I'm a staff member looking after a patient, am I going, if I've sent off a poo sample, am I gonna be told that they've got a Gram-negative bug?
Or is it only if it has a resistance? Will I be told?
[00:04:33] Elaine: Yeah, So everybody will carry them, especially like as you get older. So when you are first born, obviously your guts don't necessarily have lots and lots of bacteria in them 'cause you've come from a lovely sterile environment in terms of being in the womb.
But as you grow and as kids crawl around and stuff, they all develop their own like almost family signature of what bacteria live in your gut, and it tends to get shared by households. So we will only tell you when there's something that you need to bear in mind. So we will tell you that a bacteria has a certain resistance pattern purely so if that bug ever gets out of that site.
So if someone has surgery, if they have lots of diarrhoea and it gets onto a line or something, then you can make sure that you are treating with something that will actually manage that bug that might be a concern because we know it's there. So a lot of the time you just get this, given this information really just to help you in case you need it in the future.
And so that we can put in the right infection precautions in place in order to just keep everybody safe. But we wouldn't treat and get rid of it. 'cause it's part of what is actually really important in every human.
[00:05:54] Kate H: I get you. Thank you for explaining. So if we're then gonna be caring for someone with a Gram-negative res bug in their stool, potentially, what should we consider doing?
Maybe if you are a staff member or if you're a parent or carer.
[00:06:11] Elaine: So I think it's really important to know that all children right, get, touch themselves, spread things around. I have nieces and nephews who will crawl all over the floor or sit their hands in their nappies like it happens. That's just normal kid behavior.
But if you are looking after, especially a younger child who you know, they're not necessarily gonna have good hand hygiene. If they're in nappies and you can have nappy leaks, then we need to know that. We have to do more work in order to get rid of that bacteria that's sitting on the skin that wouldn't normally be there, right?
That might get onto a sterile wound dressing or something so that you wouldn't necessarily have to, if you had a continent older child who's capable of washing their hands before they interact. And who's less likely to be exploring the world physically? 'cause that's what younger kids do.
And so it's really important to take note of when things have happened. So, if your child has an incident with a nappy where actually they get stool and all poo on them out beyond the nappy line. That's the kind of thing that we might need to pay attention to because you are gonna have to clean up that skin much better than you might do if your child was not got lines or other things in place or other kind of wounds and abrasions 'cause what you don't want is that them. Moving around their skin and risking contamination at other places. If you have an incident with a line, especially like some of our kids are really small and so their lines are dangle and there's not that much of them, there's not much that much difference between the nappy line and where your line is.
Then if something happens and we need to, if you are a parent, you've seen it, you need to be letting someone know. If you're a member of staff, then we need to think about what we do with that line in order to make sure that it stays safe and stays clean and so that we're not transferring anything.
And the other thing I think to really be aware of is because these things naturally will live in the gut. If you've got stuff going on with the gut in your child, or if you notice that your child suddenly has diarrhoea or a swollen tummy, things that might mean that actually there's a blockage they've got, they're not managing to get normal bowel movements. Then you might need to think about actually is that increasing their risk of the bugs getting out of their gut into their bloodstream, those kinds of things, and that's really difficult to manage, but it's worth. If you are looking after a child, being aware of it.
'cause I think often when we think about things like what we call bacteraemia, so that's blood, that's bugs in the blood. Then we often have always thought about things like kids with lines or urinary catheters. But for these organisms, sometimes if you've got an inflammation on or you've got a blockage, then actually the bugs can get through from like the lining of the gut into the blood directly. Okay. And so it's a different type of risk to what we might get with something like MRSA in a line. And so it's just all talking about that and making sure that we keep an eye on actually, do we have abdominal swelling.
Do we have anything that could indicate there's something going on there that we need to get on top of as members of staff in order to really be aware and get on top of these kinds of things early and managing them early to reduce the risk to patients.
[00:09:51] Kate H: Yeah, get you. And so I guess my only other question before we wrap up is then if your child's got symptoms, is that the point that you're testing for a Gram-negative bug or are we testing at different times for different patients?
[00:10:06] Elaine: So we'll always try and test your child. So when you get asked to give a stool sample, if they can get a stool sample we always try to test them when they come into hospital so we know what's going on outside of everything else. So it's really important for us to know what they've got on board.
If they then go on and get other symptoms or they stay in hospital for more than 30 days, we'll test again. And that's just because actually while they're here, we're probably giving them other antibiotics or we might be giving them other treatments. That cause those bugs to change a bit. And we wanna know what those changes are for while they're here.
And so we will keep an eye on it. We will also take extra samples if they do have symptoms. So if they do get a bit of a temperature, if they do have like diarrhoea or other things going on, then we'll take samples then to understand, is it caused by the bacteria? It might not be, but it's useful for us to have an idea of what's going on so that we can make sure that we get on top of any treatment as soon as possible if we need to.
[00:11:09] Kate H: That makes sense and it makes sense with all the other podcasts actually that we've covered as well. So just to wrap up, what would you say are the sort of top three key messages for people to take home about Gram-negative resistant bugs.
[00:11:27] Elaine: I think the first thing is to say we all have Gram-negative bugs on us.
That they live with us actually as humans. We couldn't survive without some of them because they produce vital vitamins and stuff for us. So just seeing the word Gram-negative is not a reason to panic. We, monitor for their antibiotic resistance because it's useful to know, but it's not necessarily doing anybody any harm.
We monitor it so that if we do get to a point where it gets out of where it should be into another site, we use the right antibiotics in order to be able to actually do that treatment. So if you see a result and you're a member of staff that gives you this information, then you use it to make sure that you are giving your patients the right thing.
And finally, if we keep an eye on our patients, if we have got kids in nappies and they have lines in or other things where they've got, reason why they, the bugs may have got out of their nappy or other places, then we need to A, note it and B, do something about it in order to try to minimise any risk associated with it.
[00:12:39] Kate H: They're all very key, common sense type things as well to take home as our take home messages. So thank you so much, Elaine. That's been really insightful and you've made quite a complex subject feel quite manageable to take in. So thank you so much. And next time you think of mammals, you'll think of a very different set of bugs.
Yes, very true. Thank you so much. And catch us again on another ICE podcast. Bye.
[00:13:09] SA: Thank you for listening to this episode. If you want to find out more about the work of the GOSH Learning Academy, you can find us on social media on Twitter, Instagram, and LinkedIn.
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