Preventing
Multidrug-Resistant Organisms
(MDROs)
What the Direct Caregiver Should Know
Prepared by:
Ann Bailey, RNC, BSN, CIC
Joanne Dixon, RN, MN, CIC
December 17, 2009
Objectives:
Upon completion of this module, the learner will:
• Define Multidrug Resistant Organisms (MDRO)
• Name 2 MDROs
• State the type of precautions to be used with
all patients and under what circumstances you
would wear gloves
• Name the type of isolation in which to place
someone with an MDRO
What are Multi-Drug Resistant Organisms?
(MDROs)
• MDROs are microorganisms, predominantly
bacteria, that are resistant to one or more
classes of antimicrobial agents
• Examples of MDROs (not all inclusive)
•
•
•
•
•
Methicillin-resistant staphylococcus aureus (MRSA)
Vancomycin-intermediate staphylococcus aureus (VISA)
Vancomycin-resistant staphylococus aureus (VRSA)
Vancomycin-resistant enterococcus (VRE)
Streptococcus pneumoniae resistant to penicillin and
other broad-spectrum agents
What are Multi-Drug Resistant Organisms?
(MDROs)
• Other Examples of MDROs
• Some gram-negative organisms with strains that have
developed the ability to produce ESBL (extendedspectrum beta-lactamase) which is an enzyme that
inactivates beta-lactam antibiotics such as the penicillins
and cephalasporins
•
•
•
•
Klebsiella pneumonia
Escherichia coli (E. Coli)
Acinetobacter baumannii
Stenotrophomonas maltophilia
Why Concern over MDRO Infections?
• Cause serious, difficult-to-treat infections that can
result in substantial morbidity, mortality, increased
lengths of stay and excess cost
• Frequently preventable –
• Usually acquired via transmission by:
caregiver-to-patient, environment-to-patient, or patient-topatient
• Judicious use of antimicrobials may decrease incidence of
microorganisms developing antibiotic resistance
What Measures Can We Take to Prevent Transmission
of MDROs?
• Hand Hygiene – The Most Important Way to Prevent
Transmission of Microorganisms and Infection
What Other Measures Can We Take to Prevent
Transmission of MDROs?
Isolation Precautions
• Follow Standard Precautions
during all patient encounters
in all settings in which healthcare
is delivered.
• Remember Standard Precautions is using appropriate
personal protection equipment (PPE) to protect against
exposure to body fluids
• Gloves, gown, mask and eye protection according to
assessed risk of exposure
What Other Measures Can We Take to Prevent
Transmission of MDROs?
Isolation Precautions
• Develop and utilize systems to identify patients
with MDROs and notify Infection Preventionists,
physicians and direct caregivers
• Place patients with a confirmed MDRO or history
of an MDRO in single-patient rooms.
• Group patients with the same MDRO in
designated areas if single-patient room
unavailable
What Other Measures Can We Take to Prevent
Transmission of MDROs?
Isolation Precautions
• Implement Contact Precautions immediately for
all patients infected with MDROs, that have a
previously identified MDRO or have a history of
being colonized with target MDROs
(Implementation of isolation
is a nursing order. It does not
require a doctor’s order.)
• Notify Infection Prevention and Control after
placing the patient in isolation
What Other Measures Can We Take to Prevent
Transmission of MDROs?
Contact Precautions
• Perform hand hygiene before donning personal
protective equipment (PPE – gown, gloves,
goggles, face shield)
• Gown and gloves worn upon entering room
• Use eye/face protection if risk of splatter/splash
is anticipated (e.g., patient is coughing or
sneezing or has trach)
• Discard PPE before leaving room
• Perform hand hygiene after
discarding PPE
What Other Measures Can We Take to Prevent
Transmission of MDROs?
Isolation Precautions
• For MDRO colonized or infected patients without
draining wounds, diarrhea, or uncontrolled
secretions, establish ranges of permitted
ambulation, socialization, and use of common
areas
• Consult Infection Prevention &
Control prior to discontinuing
isolation on a patient even if a
physician has written an order for such
What Measures Can We Take to Prevent Transmission
of MDROs?
Environmental Measures
• Clean and disinfect high-touch surfaces
(eg bedrails, faucet handles) and
equipment used in the patient’s
environment that may be contaminated
with pathogens
• Dedicate noncritical medical items for use on
patients known to be infected or colonized with
an MDRO
• Infected: organisms present, tissue invasion and
symptoms are present
• Colonized: organisms present but no tissue invasion
and patient is asymptomatic
What Other Measures are Seton Family of
Hospitals Taking to Prevent Development of
MDROs?
Judicious use of Antimicrobial agents
• Monitoring appropriate use of antimicrobial
agents
• Periodic development and
distribution of antibiograms
• Educating clinicians regarding appropriate
prescribing of antimicrobial agents
In Summary – Prevention of MDROs
• Hand Hygiene, Hand Hygiene, Hand Hygiene
• Isolation Precautions
• Standard Precautions for all patients
• Contact Precautions for patients identified as having an
MDRO
• Environmental Measures
• Judicious use of Antimicrobial agents
Your Role
• Follow the above recommended practices and measures
specific to your role in the patient’s care
• Provide appropriate/indicated patient teaching regarding
these recommended practices
• Document patient education related to the goal of
prevention of MDROs
• Patient education materials related to infection prevention
can be found on the Intranet:
• http://intranet.seton.org/polandproc/infectcontrol/fact_and_e
ducation_sheets/index.php
• Remind peers of the importance of following the
recommended practices if they are observed to be noncompliant
Questions?
• Contact the Infection Preventionist at your site
References
• http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroG
uideline2006.pdf