Affinity Health Services, Inc.
Title of Policy: Multi-Drug Resistant Organisms
Location of Policy: Infection Control Manual
Effective Date: December 2007
Prepared by:
Revision Dates:
MES
Total pages: 4
Attachments:
Approved by:
MES
Multi-Drug Resistant Organisms
Highlights
Policy Statement
Appropriate precautions will be taken when caring for individuals known
or suspected to have infection or colonization with a multi-drug resistant
organism. (Note: Infection means that the organism is present and is
causing illness. Colonization means that the organism is present in or
on the body but is not causing illness.)
Policy Interpretation and Implementation
Definitions
1. Multi-drug resistant organisms (MDROs) are bacteria and other
microorganisms that have developed resistance to one or more classes
of antimicrobial drugs. Common examples of MDROs in long-term care
facilities include MRSA (methicillin/ oxacillin-resistant Staphylococcus
aureus) and VRE (vancomycin-resistant Enterococci). In addition, gramnegative bacilli (GNB) (e.g., Escherichia coli, Klebsiella pneumoniae,
Acinetobacter) and multi-drug resistant Staphylococcus pneumoniae
have been identified as emerging MDRO threats in long-term care.
2. Persons who have Staphylococcus aureus resistant to nafcillin,
oxacillin, or methicillin will be considered to have MRSA, no matter what
other antibiotic sensitivities are identified for the organisms.
Standard Precautions
3. Staff will use standard precautions as the primary approach to
preventing transmission of MDROs.
4. Caregivers should wash their hands with soap and water after
physical contact with the infected or colonized person and before
leaving the facility.
5. Masks are not recommended for routine use in caring for residents
with MDRO infection or colonization unless performing splashgenerating procedures (e.g., wound irrigation, oral suctioning,
intubation), caring for open tracheostomies, or there is a high-risk of
transmission from heavily colonized areas (e.g., large, draining
wound).
Contact Precautions
6. The staff and practitioner will evaluate each individual known or
suspected to have infection or colonization with a multi-drug resistant
organism for room placement and initiation of Contact Precautions on a
case-by-case basis.
7. The Centers for Disease Control and Prevention does not have
recommendations for pre-screening residents prior to or upon
admission. However, the Infection Control Team or Medical Director
may implement or consider the following to determine the need for
Contact Precautions and/or room placement:
a. The individual’s ability to contain infected/colonized body fluids or
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body site;
b. Personal hygiene of the resident (e.g., handwashing, keeping hands
away from infected/colonized areas); and
c. Risks for transmission including uncontrolled secretions, stool
incontinence, draining wounds, diarrhea, and total dependence for
activities of daily living.
8. Should a resident be placed on Contact Precautions implement the
following:
a. Consult appropriate isolation policy;
b. Place a box of gloves in the room;
c. Have supply of gowns readily available;
d. Place linen hamper at door frame of room;
e. Make antiseptic handwashing agent and/or approved alcohol-based
hand disinfectant available;
f. Place facility-specific signs/stickers on the door, and on the chart; and
g. Explain procedures/precautions to family members.
Room Placement
9. A resident with a multi-drug resistant organism may need to be
separated from a roommate who has any of the following: a device such
as an indwelling urinary catheter, gastrostomy feeding tube, or
intravenous access line, a pressure ulcer or other open skin wound
including a postoperative wound, or significant immunosuppression
(due to malignancy, chemotherapy, etc.). However, if the at-risk
roommate is already colonized with the same multi-drug resistant
organism, separation is not necessary.
10. The resident need not be moved from his/her room until after
screening is done and the need for Contact Isolation is determined.
11. Depending on the situation, placement may include the following:
a. Placement in a room with someone else who is colonized or infected
with the same organism, but does not have any other infection
(cohorting);
b. Placement with someone who does not have risk factors for
infection; or
c. Placement in a private room, if possible.
12. A resident who is infected or colonized with a multi-drug resistant
organism will be permitted to participate in group meals and activities if
draining wounds are covered, bodily fluids are contained, and he/she
observes good hygiene practices.
13. Personnel with open skin lesions or who are immunocompromised
will not care for residents with MRSA or other multi-drug resistant
organisms.
Discontinuing Contact
Precautions
14. Residents who are placed on Contact Precautions will remain so
until a clear culture report has been obtained or until it is determined
that they no longer present a risk of transmission.
15. A resident will be considered free of a multi-drug resistant organism
(and no longer a risk of transmission) if three successive culture results
taken a week apart are negative or by facility specific policies e.g.
MRSA, VRE, C-Diff.
16. Contact precautions or isolation may not be discontinued until the
Infection Control Coordinator reviews the situation and the Attending
Physician approves of the discontinuation.
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17. Upon approval from the Infection Control Coordinator and Attending
Physician, a resident who has had a multi-drug resistant organism at a
site that has healed (or who has recovered from bacteremia or sepsis
due to a multi-drug resistant organism) may be removed from Contact
Precautions without having a repeat culture of the site.
Environmental
Precautions
18. In general, healthy visitors and volunteers may have casual contact
with individuals who are colonized or infected with a multi-drug resistant
organism, as long as any secretions, drainage, body fluids, etc., from
the resident can be contained. Visitors should wash their hands before
leaving the room of someone who is infected or colonized with a multidrug resistant organism. They should wear disposable gloves if contact
with body fluids is expected and if excessive contact with body fluids is
expected, gowns should also be worn. It is also acceptable for infants
and children to have casual contact with these residents.
19. For residents with colonization or infection with MDROs, non-critical
resident-care items will be dedicated for individual use.
20. Towels used for drying hands after contact should be used only
once.
21. Disposable gloves should be worn if contact with body fluids is
expected and hands should be washed after removing the gloves.
22. Linens should be changed and washed if they are soiled and on a
routine basis.
23. The resident’s environment should be cleaned routinely and when
soiled with body fluids.
Surveillance and
Communication
24. If an MRSA outbreak is suspected, contacts (roommates) of
residents with MRSA should have surveillance Staphylococcus screens
of major wounds and anterior nares.
25. Complete surveillance documentation (e.g., line history, reports) for
residents who have a multi-drug resistant organism
infection/colonization.
26. The nursing staff and/or Infection Control Coordinator will indicate
prominently in the medical record if a resident is currently infected or
colonized with a multi-drug resistant organism.
27. If there is a first case or outbreak of an epidemiologically important
MDRO (MRSA, VRE, VISA, VRSA, MDR-GNB), surveillance of target
MDRO infection will be initiated.
28. If a resident who is colonized or infected with a multi-drug resistant
organism is transferred to another facility, the Infection Control
Coordinator/Director of Nursing Services at that institution will be
notified.
29. Notify physicians and other healthcare personnel who provide care
for the resident that the resident is colonized/infected with a multi-drug
resistant organism.
Intensified MDRO
Control Efforts
30. If prevalence of MDROs are not controlled through the use of
routine control measures, the Infection Control Coordinator will initiate
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intensified control efforts, which may include:
a. Consultation from persons with experience in the infection control
and epidemiology of MDROs;
b. Review of facility spread of MDROs;
c. Intensified training of staff and personnel;
d. A clinical review of the use of antimicrobial drugs;
e. Active surveillance cultures from residents at risk;
f. Intensified surveillance of targeted MDROs;
g. Initiation of Contact Precautions for all residents infected or colonized
with MDROs;
h. Implementing policies for resident admission and placement as
needed;
i. Implementing resident-dedicated use of non-critical care items;
j. Monitoring environmental services for compliance with cleaning and
disinfecting procedures;
k. Obtaining environmental cultures;
l. Consulting with experts on decolonization therapies for residents and
staff.
OBRA Regulatory
Reference Numbers
Related Documents
References
483.65(a); 483.65(b)(1); 483.65(b)(3); 483.65(c)
Survey Tag Numbers F441; F442; F444; F445
Management of Multi-Drug Resistant Organisms in Healthcare Settings
2006; CDC Campaign to Prevent Antimicrobial Resistance in
Healthcare Settings; Transmission-Based Precautions; Specific
policies for MRSA, VRE, and C-Diff
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