Isolation Precautions for MDROs
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MDROs are microorganisms that are resistant to one or more classes of antimicrobial agents such as MRSA, VRE, and certain gram-negative bacteria. They are transmitted through the same routes as other pathogens but can be more difficult to treat. Hospitals have implemented isolation precautions and infection control strategies to prevent transmission and properly manage MDROs. These include contact precautions, surveillance testing, antibiotic stewardship programs, and guidelines from the CDC for identifying and containing MDROs, especially for at-risk patients and units. A multidisciplinary approach is needed between clinical staff, microbiology laboratories, and infection prevention teams to effectively control MDROs.
Isolation Precautions for MDROs
- 1. Isolation P recautions for Preventing T ransmission of MDROs Anuj Sharma Senior Consultant Clinical Microbiology Sir Ganga Ram Hospital
- 2. MDROs Microorganisms – predominantly bacteria – that are resistant to one or more classes of antimicrobial agents MRSA, VRE, MDRGNB (+ESBL), MDRSP, VISA, VRSA Usually R to all except few ABs – epidemiologically important Acinetobacter, Burkholderia cepacia, Klebsiella, Enterobacter, Pseudomonas aeruginosa, Transmission Same routes as antimicrobial S organisms Patient-to-patient transmission, usually via hands of HCWs, especially for MRSA and VRE
- 3. MDROs Progressive increase esp. in acute care settings Prevalence variation - geographic, institutional, patient care unit, temporal Impact variation Colonisation , infection >> treatment (more difficult & prolonged) L o S, morbidity, mortality, cost Relationship to antimicrobial exposure, especially for GNBs
- 4. MDRO Control Standard / Contact precautions Strategies Infection prevention Accurate / prompt diagnosis & treatment Prudent use of ABs Prevention of transmission CDC Guidelines for Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006 http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf
- 5. Control of MDROs Two- tiered approach First Tier : Baseline activities for all settings Second Tier : More intense and focused control efforts Triggers to escalate to second tier MDRO identification in high - risk patients or unit Failure to reduce MDRO despite first tier efforts
- 6. Pg 73
- 7. Pg 74
- 8. Control interventions Administrative measures MDRO education Judicious use of antimicrobials Surveillance Infection control precautions Environmental measures Decolonisation
- 9. Top 4 control measures MRSA Surveillance cultures of patients Contact precautions Decolonisation Hand hygiene VRE Surveillance cultures of patients Contac t precautions Extra cleaning and disinfection Education of staff, patients or visitors MDR GNB Contact precautions Surveillance cultures Education of staff, patients or visitors Hand hygiene
- 10. Isolation guidelines Contact precautions Patient placement Category II Single pt. room preferred; prioritize for single room based on presence of conditions that facilitate transmission Cohort in one room patients with same pathogen, but maintain separation >3 feet, change protective attire, use hand hygiene between different patients Don gowns & gloves upon room entry Category IB Droplet precautions Don surgical mask upon room entry Category IB
- 11. C linical microbiology lab Antimicrobial ST testing & interpretation Surveillance cultures Antibiogrammes, MDRO incidence / infection rates Colonisation / Infection Molecular typing Rapid diagnostic tests Detection & rapid reporting of MDROs QC programme Multidisciplinary approach for judicious use of ABs