Multi-Drug Resistant Organisms
(MDROs) in Michigan
NOREEN MOLLON, MS
INFECTION PREVENTION CONSULTANT
www.michigan.gov/hai
Objectives
 Describe MDROs
 MDRO surveillance and reporting
 SHARP Prevention Initiatives
 Recent MDRO investigations
 IP practices for MDROs
Describing MDROs
What is a MDRO?
 Multidrug-Resistant Organisms (MDROs) are
defined as microorganisms, predominantly bacteria,
that are resistant to one or more classes of
antimicrobial agents (HICPAC)
 Deserve special attention in healthcare facilities–
Healthcare-Associated Infections (HAIs)
 Clinically significant
 Associated with increased lengths of stay, costs, and
mortality
Types of MDROs
 MRSA
 VISA
 VRSA
 VRE
 C. Diff
 MDR GNB
 Escherichia coli, Klebsiella pneumoniae, Pseudomonas
aeruginosa, Acinetobacter baumannii
 ESBLs
 CRE
What is MRSA?
•
MRSA:
o Methicillin
o Resistant
o Staphylococcus
aureus
Staphylococcus aureus are Gram positive
bacteria that can be transmitted from person-toperson in a healthcare facility or in the community
MRSA is a staph infection that is resistant to βlactam antibiotics (like methicillin, penicillin, and
amoxicillin)
o
•
•
Methicillin-Resistant Staphylococcus aureus
(MRSA)
 MRSA
 >40% of US hospital-associated S. aureus infections
 >50% of ICU-associated S. aureus infections
 Increasing reports in non-healthcare settings
 Prisons
 Schools
 Day-care
 Workplace
 Other
 Approximately 1% of the general population is
colonized with MRSA
VISA
 Vancomycin-intermediate Staphylococcus aureus
 Vancomycin minimum inhibitory concentration
(MIC) =4–8 µg/mL
 Isolate must be confirmed at MDCH laboratory
 Resistance mechanism is not transferrable to
susceptible strains and is usually associated with
vancomycin exposure
VRSA
 Vancomycin-resistant Staphylococcus aureus
 Vancomycin minimum inhibitory concentration
(MIC) 16 µg/mL
 Isolate must be confirmed at MDCH laboratory
 Resistance is acquired from VRE and is transferrable
VRE
 Vancomycin-resistant
Enterococcus
 Can colonize the
intestines and female
genital tract
 Can cause infections of
the urinary tract, the
bloodstream, or of
wounds associated with
catheters or surgical
procedures
Clostridium difficile (C. diff)
 Background
 Accounts for 15-25% antibiotic-associated diarrhea
 80% Clostridium difficile infection (CDI) associated
with healthcare
 Elderly and patients on antibiotics at highest risk
 Current epidemiology
 Increased rates nationwide
 Increased severity and mortality
 Reasons
 Widespread use of antibiotics
 Changes in infection control practices
 New strain: NAP-1
MDR GNB
 Multidrug-resistant gram-negative bacilli
 Can refer to various organisms:
 Escherichia coli, Klebsiella pneumoniae,
Pseudomonas aeruginosa, Acinetobacter baumannii,
Stenotrophomonas maltophilia, Burkholderia cepacia,
and Ralstonia pickettii
MDR GNB
 Grouped according to resistance
 Extended-spectrum β-Lactamases (ESBLs)
 Carbapenem-resistant Enterobacteriaceae (CREs)
Carbapenemase-producers (such as Klebsiella pneumoniae
carbapenemase or KPC)
 Metallo-beta-lactamase (MBL)-producers

 Difficult to lab confirm
 Worrisome public health threat
What is a HAI?
 Healthcare-Associated Infections (HAIs) are
infections that patients acquire during the course of
receiving healthcare treatment for other conditions
that were not present at admission
 HAIs are often MDROs
 Are frequently device-associated
HAIs
 Approximately 1 out of every 20 hospitalized
patients will contract an HAI
 CDC estimated that 1.7 million HAIs occurred in
US hospitals in 2002
 HAIs are responsible for about 100,000 deaths in
the US annually
 The medical costs associated with these infections
are approximated to be between $36-45 billion
Types of HAIs
 Central Line-Associated Blood Stream Infections
(CLABSI)
 Catheter-Associated Urinary Tract Infections (CAUTI)
 Ventilator-Associated Events (VAE)
 Surgical Site Infections (SSI)
 Clostridium difficile (C.diff) Infection
 Methicillin-Resistant Staphylococcus aureus (MRSA)
 Multidrug-Resistant Organisms (MDROs) –
Acinetobacter, Klebsiella, Pseudomonas,
Enterobacter, E.coli, etc.
Types of HAIs
SSI
CLABSI
Surgical incision showing signs of infection
Subclavian central venous line
VAE
CAUTI
Foley catheter insertion kit
Mechanical ventilator
CDI LabID
MRSA LabID
Staphylococcus aureus
Clostridium difficile
Costs of HAIs*
Meta-analysis results of top 5 HAIs
Infection
Cost/Infection
Attributed
LOS(Days)
Total annual cost
($, billions)
Total annual
cases
CLABSI
$45,814
10.4
1.85
40,411
SSI
$20,785
11.2
3.30
158.369
VAP
$40,144
13.1
3.09
31,130
C. Diff
$11,285
3.3
1.51
133,657
CAUTI
$896
--
0.28
77,079
* source: JAMAInternalMedicine, 9/2/2013
MDRO Surveillance and Reporting
Surveillance and Reporting
www.michigan.gov/hai
 33 states have laws requiring HAIs to be reported to state health
departments, the majority of which publically release hospital HAI
rates
National Reporting Requirements
 The Centers for Medicare and Medicaid Services
(CMS) requires hospitals to report:





CLABSI (effective January 2011)
CAUTI (effective January 2012)
SSI for Colon Surgeries and Abdominal Hysterectomies
(effective January 2012)
MRSA Bacteremia LabID (effective January 2013)
C. difficile LabID (effective January 2013)
Bureau of Disease Prevention, Control and Epidemiology
www.michigan.gov/epi
Division of Communicable Disease
www.michigan.gov/mdch/0,1607,7-132-2945_5104-12219--,00.html
Surveillance and Infectious Disease Epidemiology Section (SIDE)
www.michigan.gov/cdinfo
Surveillance for Healthcare-Associated and Resistant Pathogens
(SHARP) Unit www.michigan.gov/hai
Education and
Outbreak Response
Provide general education
and recommendations
based on current bestpractice, evidence-based
guidelines
Prevention
Initiatives
Carbapenem-Resistant MRSA/CDI Prevention
Collaborative
Enterobacteriaceae
(CRE) Prevention
Collaborative
Surveillance
Collect HAI data from
Michigan hospitals
through the CDC’s webbased National
Healthcare Safety
Network (NHSN)
Authority of State and Local HDs
• Michigan is a “home rule” state, meaning local HDs
have autonomy within their jurisdiction
• The MDCH operates independently from the local
HDs
• The primary role of the MDCH in communicable
disease control is to provide:\
o
o
o
o
o
Expert consultation
Reference level diagnostics laboratory services
Childhood vaccines
Support local HDs upon their request
Maintenance and administration of the MDSS
• All communicable disease reports should be
reported to your local HDs
Public Health Investigative Authority
 State and local HD personnel are authorized to
investigate reported diseases, including:





Contacting health providers
Conducting additional case-finding
Conducting epidemiological studies
Conducting specimen collection
Gathering information on medical history, lab results,
diagnostic procedures, treatment, and health outcomes
 The MDCH works collaboratively with the local
HDs and participates in investigations when
requested
Confidentiality, HIPAA, and PHI
 Disclosure of protected health information (PHI)
to health authorities without individual consent or
authorization is permitted when disclosure is
required by law or is authorized by law for a public
health purpose (www.hhs.gov/ocr/hipaa/)
 All information provided to public health
authorities is kept confidential
Map of Michigan Local HDs
Communicable Disease Surveillance
 Communicable disease reporting is required by
Michigan law:



Michigan Public Health Act No. 368 Communicable Disease
Rules: R 325.171-3, 333.5111
Rule revision allows the State the right to periodically
update the list of reportable diseases
This reporting is expressly allowed under HIPAA
Hepatitis C Virus
Neisseria meningitidis
Histoplasma capsulatum
Bordetella pertussis
Why Communicable Disease Surveillance is
Important
 To identify outbreaks
 To assure treatment, preventive treatment and/or




education
To evaluate prevention and control programs
To help target prevention resources
To facilitate epidemiologic research
To assist national and global surveillance efforts
Chlamydia trachomatis
Influenza Virus
Mycobacterium tuberculosis
Salmonella sp.
Communicable Disease Reporting Entities
• Physicians*
• Laboratories*
• Hospital ICP
• Private citizens
• School systems*
• Pharmacists
• Veterinarians
• Medical Examiners
*Required to report
• Hospitals*
• Child care facilities
• Long-term care
facilities*
• Pre-hospital
emergency services
o Police
o Fire
o EMS
Communicable Disease “Brick Book”
 The current 2012 version
(electric crimson), provides a
good summary of the
communicable disease rules,
requirements, and
responsibilities
Michigan Reportable Diseases
 ~90 disease/conditions
are reportable in Michigan
 Also reportable are
‘unusual occurrences’,
outbreaks and epidemics
of any disease or
condition (including
healthcare-associated
infections)
 Specific reporting rules
and definitions can be
found at
www.michigan.gov/cdinfo
Michigan Reportable MDROs and HAIs
 Vancomycin-Intermediate Staphylococcus aureus
(VISA) and Vancomycin-Resistant Staphylococcus
aureus (VRSA) are required to be reported according
to the communicable disease rules
 Unusual occurrences and outbreaks of HAIs are also
mandated by law to be reported
 However, individual HAIs (like a CLABSI), are not
required to be reported to state or local health
departments
Surveillance of Healthcare Associated and
Resistant Pathogens(SHARP) Activities
www.michigan.gov/hai
 Surveillance and Reporting
 MDRO Prevention Initiatives
 Consulting/Education
 Outbreak Response
Staphylococcus aureus
Klebsiella pneumoniae
Clostridium difficile
SHARP Unit
 Objectives of the SHARP Unit:
 Coordinate activities related to HAI surveillance and
prevention in Michigan
 Improve surveillance and detection of antimicrobialresistant pathogens and HAIs
 Identify and respond to disease outbreaks
 Use collected data to monitor trends
 Educate healthcare providers, state and local public health
partners, and the public on HAIs
www.michigan.gov/hai
NHSN Surveillance Initiative
www.michigan.gov/hai
 In Michigan, hospitals can voluntarily report HAIs to
MDCH SHARP via the National Healthcare Safety
Network (NHSN)
 NHSN is a web-based surveillance program designed
by CDC:


Uses standardized HAI surveillance definitions
Users can enter and analyze HAI data
 The data sent to SHARP from Michigan hospitals are
de-identified and the numbers aggregated for the
purposes of producing state-wide HAI surveillance
reports
NHSN Surveillance
www.michigan.gov/hai
 HAIs tracked by MDCH SHARP surveillance:
 Central Line-Associated Blood Stream Infection (CLABSI)
 Surgical Site Infection (SSI)
 Catheter-Associated Urinary Tract Infection (CAUTI)
 Ventilator-Associated Pneumonia (VAP)
 Clostridium difficile LabID surveillance
 MRSA LabID surveillance
 Antimicrobial resistance in select pathogens
SHARP Surveillance Reports
www.michigan.gov/hai
 SHARP releases state-wide HAI reports quarterly,
semiannually, and annually which are posted at
www.michigan.gov/hai


All hospital data is de-identified and aggregated
Individual hospital data is not made public
 SHARP also compiles hospital specific HAI reports
which are only shared with those individual
hospitals
SHARP Surveillance
www.michigan.gov/hai

Currently there are 83 Michigan hospitals sharing HAI data with SHARP, 82 hospitals
releasing their data to the Michigan Health and Hospital Association MHA Keystone Center,
and 13 hospitals releasing their NICU data to the Vermont Oxford Network (9/26/13).
Number of Acute Care Hospitals that have Signed a Data
Use Agreement with MDCH SHARP
90
Master Agreement
80
MHA Data Release
Number of Hospitals
70
VON Data Release
60
50
40
30
20
10
0
2009
2010 Q1 2010 Q2 2010 Q3 2010 Q4 2011 Q1 2011 Q2 2011 Q3 2011 Q4 2012 Q1 2012Q2 2012Q3 2012 Q4 2013Q1 2013 Q2
2013
Q3*
SHARP HAI Data: MRSA Lab ID
www.michigan.gov/hai
MRSA LabID Rates
MRSA LabID Rate per 1,000 Patient Days
6
5
4
3
2
1
0
2011 Q1
2011 Q2
2011 Q3
2011 Q4
2012 Q1
2012 Q2
2012 Q3
2012 Q4
SHARP HAI Data: CDI LabID
www.michigan.gov/hai
C. diff LabID Rates
C. diff LabID Rate per 10,000 Patient Days
25
20
15
10
5
0
2011 Q1
2011 Q2
2011 Q3
2011 Q4
2012 Q1
2012 Q2
2012 Q3
2012 Q4
SHARP HAI Data: SIR
www.michigan.gov/hai
Standardized Infection Ratios (SIR)
2012 Quarter 4
Type of
Infection
Number of Procedures
Hospitals Done
CAUTI5
CLABSI6
SSI7
SSI COLO8
SSI HYST9
MI Data
75
73
72
69
67
N/A
N/A
11,954
2,111
2,109
Device Days Observed1 Predicted2 MI
SIR3
99,581
89,342
N/A
N/A
N/A
232
86
233
91
35
215.972
179.784
267.056
122.292
39.824
1.074
0.478
0.872
0.744
0.879
MI pvalue
0.1456
<0.0001
0.0184
0.0019
0.2509
MI 95% CI4
0.940, 1.222
0.383, 0.591
0.762, 0.994
0.596, 0.917
0.607, 1.230
US Data
Green Font: SIR demonstrates statistically significantly fewer infections than expected
Red Font: SIR demonstrates statistically significantly more infections than expected
1Observed:
Number of infections (CAUTI, CLABSIs or SSIs) reported during the time frame.
The number of CAUTIs or CLABSIs predicted based on the type of hospital unit(s) under surveillance, or the number of SSIs predicted based upon 2009 national SSI rates by procedure type.
3SIR: Standardized Infection Ratio: Ratio of observed events compared to the number of predicted events, accounting for unit type or procedure. An SIR of 1 can be interpreted as having the same number of
events that were predicted. An SIR that is between 0 and 1 represents fewer events than predicted, while an SIR of greater than 1 represents more events than expected.
495% CI: 95% confidence interval around the SIR estimate. A 95% CI indicates that 95% of the time, the actual SIR will fall within this interval.
5CAUTI: Catheter-Associated Urinary Tract Infection. CAUTIs are defined using symptomatic urinary tract infection (SUTI) criteria or Asymptomatic Bacteremic UTI (ABUTI) criteria. UTIs must be catheterassociated (i.e. patient had an indwelling urinary catheter at the time of or within 48 hours before onset of the event).
6CLABSI: Central Line-Associated Blood Stream Infection. CLABSIs are laboratory-confirmed bloodstream infections (LCBI) that are not secondary to a community-acquired infection, or an HAI meeting
CDC/NHSN criteria at another body site. BSIs must be central line associated (i.e., a central line or umbilical catheter was in place at the time of, or within 48 hours before, onset of the event).
7SSI: Surgical Site Infection. Includes any superficial incisional, deep incisional, or organ/space SSI.
8SSI COLO: Colon surgeries
9SSI HYST: Abdominal Hysterectomies17.
2Predicted:
SHARP HAI Data: CLABSI
www.michigan.gov/hai
CLABSI Rates from Data Shared with MDCH SHARP through NHSN (MI vs. US)
1.8
1.6
CLABSI Rate
1.4
1.2
MI CLABSI
1
US CLABSI
0.8
0.6
0.4
0.2
0
2009-2010 Annual Report
2010-2011 Semi-Annual Report
Time Period
SHARP HAI Data: CAUTI
www.michigan.gov/hai
Michigan Overall CAUTI SIR
1.6
1.4
1.2
SIR
1
0.8
0.6
0.4
0.2
0
2011Q1
2011Q2
2011Q3
2011Q4
2012Q1
2012Q2
2012Q3
2012Q4
2013Q1
SHARP HAI Data: CAUTI
www.michigan.gov/hai
Michigan Original 25 Hospitals CAUTI SIR
1.6
1.4
1.2
SIR
1
0.8
0.6
0.4
0.2
0
2011Q1
2011Q2
2011Q3
2011Q4
2012Q1
2012Q2
2012Q3
2012Q4
2013Q1
MDCH Prevention Initiatives
MRSA/C. DIFF
CRE
MDRO Prevention Initiatives
Staphylococcus aureus
 SHARP also has started two prevention initiatives aimed
to reduce the incidence and prevalence of MDROs in
healthcare facilities in Michigan:

Methicillin-Resistant Staphylococcus aureus (MRSA)
and Clostridium difficile (CDI) prevention initiative

Carbapenem-Resistant Enterobacteriaceae (CRE)
surveillance and prevention initiative
Citrobacter freundii
Escherichia coli
Klebsiella pneumoniae
Enterobacter cloacae
MDRO Prevention Initiatives
www.michigan.gov/hai
 SHARP recruited facilities into the two initiatives
 Both will measure the baseline prevalence and
incidence of their respective organisms
 Then there will be a period of measurement during
which facilities are encouraged to begin
implementing infection prevention interventions to
reduce the transmission of these organisms
Planning Stage
Baseline Stage
Intervention Stage
MDRO Prevention Initiatives
 MRSA/CDI Contact- Gail Denkins
DenkinsG@michigan.gov
 CRE Contact- Brenda Brennan
BrennanB@michigan.gov
www.michigan.gov/hai
MRSA/CDI Prevention Collaborative
Established September 28, 2011 and includes
representation from:
• MDCH
• Michigan Society for Infection Prevention
and Control (MSIPC)
• Michigan Health and Hospital
Association(MHA) Keystone Center for
Patient Safety and Quality
• MPRO (Michigan's Quality Improvement
Organization)
• Long Term Care
• Michigan Association of Local Public Health
(MALPH)
MRSA/CDI Prevention Collaborative
 The Collaborative works to integrate
evidence based best practices along the
continuum of care to reduce and
eliminate the occurrence of MRSA and
CDI among Michigan citizens
The Initiative Focus
• Acute care and skilled nursing care facilities can
work together to reduce MRSA and CDI among
patients that share the health care services provided
within their regions
• Recognize the benefits of improving transfer of care
communication
• Build collaborative community relationships with
focus on sharing best practices to prevent and
reduce MRSA and CDI infections
MRSA/CDI Prevention Initiative
• Design of the program was formed by the
•
•
•
•
MRSA/CDI Collaborative
Facilities submitted formal applications
13 hospital and 12 skilled nursing facilities were
chosen by the MRSA/CDI Collaborative committee
Facilities were provided MSIPC scholarships to
attend conferences and training
Facilities are required to submit a formal action
plan, submit monthly MRSA/CDI event data
Cost Analysis
• Healthcare-associated infections (HAIs) in acute care
hospitals and long term care facilities impose significant
economic consequences on the healthcare system.
• The overall annual direct medical cost of HAIs to U.S.
hospitals ranges from $35.7 to $45 billion (in 2007
dollars).
• This report utilizes published results from medical and
epidemiological literature to provide a healthcare cost
estimate for treating methicillin-resistant Staphylococcus
aureus and Clostridium difficile Infection (MRSA/CDI) in
Michigan.
MRSA Results
Facility Type
Healthcare Onset Cost Total Cost
Acute Care
$ 9,245,800
$ 24,627,400
Skilled Nursing Facility
$ 381,900
$ 445,300
* Data represents 14 months of data collection at enrolled facilities
C.Diff Results
Facility Type
Healthcare Onset Cost Total Cost
Acute Care
$ 7,595,100
$ 17,878,500
Skilled Nursing Facility
$ 452,400
$ 522,000
* Data represents 14 months of data collection at enrolled facilities
CRE Surveillance and Prevention Initiative
 Develop a practical reporting mechanism for CRE, enroll acute care and LTAC




facilities to participate, and identify best-practice recommendations that can be
applied across the healthcare continuum.
 The overall goal is to build a regional, public health model to reduce
the spread of CRE in Michigan.
Twenty one facilities (17 acute care and 4 long-term acute care facilities) enrolled
into the Initiative.
Facilities are distributed across the state, with the greatest concentration in SE and
West Michigan.
Facilities voluntarily report cases of CRE (per our surveillance definition) and
submit monthly denominator reports.
Facilities developed CRE Prevention Plans designed for the specific needs of their
facility. These plans were implemented in March 2013.
More information about the CRE Surveillance and Prevention Initiative is available
online at www.michigan.gov/hai under MDCH Prevention Initiatives.
Data Highlights
September 2012 – September 2013
CRE Patient Demographics
• Total of 191 cases reported
• Age
– Median: 66 y/o
– Range: 21-96 y/o
• Sex
– 50% Female
• Patient Type
– Inpatient ICU: 40%
– Inpatient Non-ICU: 50%
– Outpatient: 9%
– Referral patient: 1%
CRE Incidence in Michigan
CRE Laboratory Testing and Micro
 Organism


Klebsiella pneumoniae: 88%
Escherichia coli: 12%
 Specimen Type


Clinical culture: 98%
Surveillance Culture or screen: 2%
CRE Contact Precautions
 Time from Antimicrobial Susceptibility Results to
placing the patient into isolation/contact
precautions:

Paired dates for 133 (of 191) acute care patients
 130 (98%) of patients were placed in CP within 24
hours

Range: 0-11 days, Mean: 3.6 hours
Outbreak Response
www.michigan.gov/hai
 The MDCH SHARP staff are available to offer our
services and expertise in healthcare-associated outbreak
investigations
Acinetobacter baumannii
 MDCH can help facilities coordinate molecular testing
with the MDCH Bureau of Laboratories to identify
genetic-relatedness between patient isolates (at no cost)
Recent MDRO Investigations
VRSA in the United States
Case No.
State
Date
1
Michigan
June 2002
2
Pennsylvania
September 2002
3
New York
March 2004
4–6
Michigan
February, October &
December 2005
7
Michigan
October 2006
8, 9
Michigan
October & December
2007
10
Michigan
December 2009
11, 12
Delaware
April & August 2010
VISA/VRSA Cases
 Most have had a history of:

Underlying health conditions including: diabetes,
hemodialysis, heart disease, obesity, osteomyelitis

Recurrent MRSA infections and non-healing wounds

Catheters and indwelling medical devices

Recent hospitalizations or stays in LTC/rehab facilities

Recent and frequent exposure to vancomycin and other
antimicrobials
CRE- Early 2013
 BOL received a short-term grant from APHL to
perform confirmatory testing of CRE isolates
 This testing yielded


Increased communications with hospitals
improvements in communications between lab and IP
 One facility implemented pre-emptive isolation of
patients from a particular LTC after identifying a
high rate of CRE positivity among those patients
Fungal Infections Associated with Contaminated
Methylprednisolone Acetate in Michigan, 2012-2013
 September 26th, 2012 – NECC voluntarily recalls
three lots of MPA (05212012, 06292012, and 08102012)
 September 28th, 2012 – Growing evidence of
connection between meningitis cases and NECC MPA
shared on multi-state call with CDC
 October 1st, 2012 –NECC customer invoice list shared
with the Michigan Department of Community Health
(MDCH) Bureau of Epidemiology
 October 2nd, 2012 – MDCH begins contacting
Michigan clinics who were recipients of recalled lots of
NECC MPA
Case Count
(as of June 3rd, 2013 http://www.cdc.gov/hai/outbreaks/meningitis-map-large.html)
68
Contributions from MDCH
 MDCH dedicated ~4,000 hours during the first
three months of the outbreak (equivalent of two
FTEs)
 Case report form completion – over 10,000 pages
of hospitalization information from fungal cases
abstracted from medical records sent to CDC:


264 case report forms, each a minimum of 27 pages in
length – totaling ~7,128 pages
277 additional admission case report forms, each a
minimum of 12 pages in length – totaling ~3,324 pages
 Sharing information to help inform national
guidelines and recommendations
IP Practices
Preventing Transmission of MDROs
Who is responsible for infection prevention?
All of us!
 We are each responsible for maintaining a safe
environment for our patients, staff, visitors,
everyone!
 We are each responsible for our own hands
Standard Precautions
 All blood, body fluids, secretions (except sweat),
nonintact skin, and mucus membranes assumed
infectious
 Includes hand hygiene, appropriate
gloves/gown/mask/face shield when necessary, and
safe injection practices
 Because colonization with MDROs is often
unrecognized, standard precautions have an
ESSENTIAL role in preventing MDRO transmission
in ALL healthcare settings
Preventing Transmission of MDROs
 Promote compliance with CDC hand hygiene





recommendations
Use Contact Precautions for all MDRO patients
(colonized and infected)
Ensure cleaning and disinfection of both equipment
and environment
Educate HCWs about MDROs
Educate and engage patients and families about
MDROs
Monitor compliance-personal accountability
Contact Precautions
 Contact Precautions are intended to prevent
transmission of organisms (MDROs) that are spread
by direct or indirect contact with a patient or a
patient's environment
 A single patient room is preferred for patients who
require Contact Precautions

When a single-patient room is not available, consultation with
infection prevention personnel is recommended to assess the
various risks associated with other patient placement options
(e.g., cohorting, keeping the patient with an existing
roommate)
Contact Precautions
 Requires putting on gown and gloves
 Perform hand hygiene before putting on gloves
 Gown must be tied at the waist and neck
 Remove gown and gloves before leaving the room
 Perform hand hygiene immediately after removing
gown and gloves
Acknowledgements
 SHARP Unit
 Jennie Finks
 Brenda Brennan
 Bryan Buckley
 Gail Denkins
 Allie Murad
 Judy Weber
 Viral Hepatitis Unit
 Joe Coyle
Resources
 www.cdc.gov/hai
 www.michigan.gov/hai
 Surveillance Initiative
 Prevention Initiatives

MRSA/CDI TTT
 www.michigan.gov/cdinfo
 http://www.apic.org/For-Consumers/Materials-for-
healthcare-facilities
Thank you
www.michigan.gov/hai