FUNCTION: Surveillance, Prevention, Control of Infection

 

TITLE: Multi-drug Resistant Organisms

 

_________________________________________________________________

PURPOSE:

To identify control measures needed to prevent the spread of multi-drug

resistant organisms.

 

DEFINITIONS:

 

Multi drug resistant organisms are human pathogens that are susceptible to two

or fewer effective antimicrobial agents.

 

Colonization is the presence of pathogenic organisms in tissue without

clinical manifestations of illness or infection.

 

Infection is the invasion and multiplication of pathogenic organisms in tissue

with clinical manifestations of symptoms of infection such as increased white

blood cell count, fever, lesions, boils and erythema.

 

Current multi-drug resistant organisms:

     *    MRSA

     *    VRE

     *    resistant Klebsiella

     *    MDR TB

     *    Ampicillin resistant Haemophilus influenza type B

     *    Penicillin resistant Strep pneumonia

 

POLICY/PROCEDURE:

 

I.   The Laboratory will promptly report all newly identified confirmed and

     presumptive cases of a multi-drug resistant organism to the

     A.   Nursing unit if the patient is still hospitalized (nursing staff

          will notify the patient's physician)

     B.   Patient's physician if patient has been discharged

     C.   Infection Control Office

 

II.  The nursing unit will promptly notify the Infection Control Office of

     multi-drug resistant organisms reported by a transferring hospital, the

     patient's physician, etc. which were cultured/identified prior to

     admission.

 

III. The nursing unit will promptly initiate and maintain additional

     precautions (Isolation) for all cases of MDRO:

     A.   Contact

          1.   MRSA                     Sign G

          2.   VRE                      Sign H

          3.   Resistant Klebsiella     Sign B

     B.   Airborne

          1.   MDR TB                   AFB Sign

     C.   Droplet                       Sign A

          1.   Ampicillin resistant Haemophilus influenza type B

          2.   Penicillin resistant Streptococcus pneumonia

 

IV.  Barriers

     A.   Gloves must be worn if in contact with the patient's blood and body

          fluids and environment.

     B.   Gowns must be worn if in contact with the patient and the patient's

          environment.

     C.   Masks with an eye shield must be worn if there is a possibility of

          being splashed with patient's body fluids.  Example: suctioning a

          tracheostomy, intubated patient, etc.

     D.   Meticulous handwashing should be done after removing gloves and

          before having contact with another patient.

     E.   Dedicate the use of all patient care equipment whenever possible. 

          All patient care items must be thoroughly disinfected with a

          hospital approved disinfectant before use by another patient.  Items

          must be bagged or thoroughly disinfected before leaving the

          patient's room.

 

V.   Patients with VRE colonization or infection will remain in isolation

     until three cultures collected 5-7 days apart are free of VRE from the

     following areas

     A.   stool or rectal swab

     B.   Perineal area, axilla or umbilicus

     C.   Open wounds and/or colostomy sites if present

 

VI.  If the patient with VRE had been in a semi-private room prior to

     identification of the VRE, obtain stool cultures or rectal swabs of any

     roommate.  If the roommate cannot be cultured, then isolation precautions

     for VRE will be initiated/maintained for the exposed roommate for the

     remainder of their hosptialization.

 

VII. Notify any receiving agency of the need for consistent handwashing and

     the appropriate use of gowns and gloves.

 

VII. Upon patient discharge or transfer to another room, notify housekeeping

     to ensure special room cleaning to include all potentially contaminated

     areas (e.g., door knobs, pulls on curtains/blinds, light switches, etc.)

     in addition to routime cleaning.

 

IX.  The patient's chart will be flagged that the patient has a multi-drug

     resistant organism so upon readmission the patient can be promptly

     identified.