Escherichia coli

Objective

To raise awareness of E. coli infections, their routes of transmission, and practical measures care home staff can take to prevent infection in residents.

Key Messages for Care Home Staff

• E. coli infections are preventable through hand hygiene, safe catheter care, proper food handling, and environmental cleanliness.
• Residents should be encouraged to maintain personal hygiene and hydration.
• Staff should escalate any suspected infections promptly to prevent complications and spread.
• Ongoing training and adherence to infection prevention protocols are critical for resident safety.

Why E. coli prevention is important

• E. coli is a bacterium commonly found in the intestines of humans and animals. Most strains are harmless, but some can cause serious illness, including urinary tract infections (UTIs), bloodstream infections, and gastrointestinal disease.
• Older adults, especially those who are frail or have indwelling catheters, are at higher risk of infection.
• Preventing E. coli infections reduces hospital admissions, antibiotic use, and complications such as sepsis.

Routes of Transmission

• E. coli can spread via:
  • Faecal-oral route - from contaminated hands, surfaces, food, or water.
  • Person-to-person contact - especially if hand hygiene is poor.
  • Medical devices - such as urinary catheters if not managed aseptically.
  • Contaminated food - particularly raw or undercooked meat, unwashed vegetables, or unpasteurised products.

Key Practices for Prevention

Hand Hygiene

• Wash hands thoroughly with soap and water before and after resident contact, after using the toilet, and after handling potentially contaminated items.
• Use alcohol-based hand rub only when hands are visibly clean.
• Encourage residents to perform hand hygiene when able.

Catheter and Urinary Care

• Follow strict aseptic non-touch technique (ANTT) when inserting or managing catheters.
• Maintain closed urinary drainage systems and empty urine bags regularly.
• Remove catheters as soon as they are no longer clinically required to reduce infection risk.

Food and Hydration Safety

• Wash fruits and vegetables thoroughly before serving.
• Cook meat to safe temperatures to destroy harmful bacteria.
• Encourage residents to drink adequate fluids daily (1.5-2L) to support urinary health.

Environmental Cleaning

• Clean and disinfect surfaces regularly using approved cleaning agents.
• Ensure toilets, commodes, and bathrooms are cleaned and disinfected daily and after contamination events.
• Isolate residents if they have diarrhoea caused by pathogenic E. coli until cleared by a healthcare professional.

Staff Education and Monitoring

• All care home staff should receive training in infection prevention and control, including hand hygiene, food safety, and catheter care.
• Monitor residents for signs of UTI, diarrhoea, or systemic infection, and escalate concerns promptly.
• Encourage early review by GP or microbiology team if infection is suspected.

Powys Environmental Health Team

• Environmental Health Officers will investigate the reporting of a resident/s with confirmed results of E.coliand will provide additional information/advice.

Resources 
Care Home Infection Prevention and Control (IPC) Resource for GI Illness: Care Home Infection Prevention and Control (IPC) Resource for GI Illness 
Beating E.Coli: Bulletin-Care-Homes-No-30-March-2021.pdf 
PCC/PTHB Gastrointestinal Infection Decision Tree. Resident Testing Isolation and Outbreak Manangement Gastrointestinal Infection (PDF, 80 KB) 

References and Further Guidance Links: 
PHW E Coli Information: Escherichia coli O157 (E. coli O157) - Public Health Wales 
Community Infection Prevention and Control Policy for Care Home settings: Outbreaks of communicable disease