Multidrug-Resistant Organisms in Non-Hospital Healthcare Settings:


 
Policy:
 
Based on current guidelines from the CDC 
http://www.cdc.gov/ncidod/dhqp/ar_multidrugFAQ.html
 
Multidrug-resistant organisms are bacteria and other 
microorganisms that have developed resistance to 
antimicrobial drugs. Common examples of these organisms 
include:
MRSA - methicillin/oxacillin-resistant Staphylococcus aureus 
 
VRE - vancomycin-resistant enterococci 
 
ESBLs - extended-spectrum beta-lactamases (which are 
        resistant to cephalosporins and monobactams) 
 
PRSP - penicillin-resistant Streptococcus pneumoniae 
 
The following multidrug-resistant organisms that are most 
commonly seen in non-hospital settings are MRSA and VRE. They 
are the most commonly encountered in patients residing in 
non-hospital healthcare facilities, such as nursing homes and 
other long-term care facilities. PRSP are more common in 
patients seeking care in outpatient settings such as 
physicians' offices and clinics, especially in pediatric 
settings.
 
Definitions: 
Colonization means that the organism is present in or on the 
body but is not causing illness.
Infection means that the organism is present and is causing 
illness.


 
Conditions that increase the risk of acquiring these 
organisms for both colonization and infection are:
ï    severity of illness 
ï    previous exposure to antimicrobial agents 
ï    underlying diseases or conditions, particularly: 
ï    chronic renal disease 
ï    insulin-dependent diabetes mellitus 
ï    peripheral vascular disease 
ï    dermatitis or skin lesions 
ï    invasive procedures, such as: 
ï    dialysis 
ï    presence of invasive devices 
ï    urinary catheterization 
ï    repeated contact with the healthcare system 
ï    previous colonization of by a multidrug-resistant 
        organism 
ï    advanced age 
 
Treating Patients in the non-hospital healthcare facilities:

Non-hospital healthcare facilities can safely care for and 
manage these patients by following appropriate infection 
control practices. In addition, non-hospital healthcare 
facilities should be aware that persons with MRSA, VRE, and 
other infections may be protected by the Americans with Disabilities Act or other applicable state or local laws or 
regulations. 
 

Preventing or controlling transmission of these pathogens in 
our facility:

CDC's recommendations for preventing transmission of MRSA / 
VRE in hospitals consist of standard precautions, which 
should be used for all patient care. In addition, CDC 

recommends contact precautions when the facility (based on 
national or local regulations) deems the multidrug-resistant 
microorganism to be of special clinical and epidemiologic 
significance. 
 
The components of contact precautions may be adapted for use 
in non-hospital healthcare facilities, especially if the 
patient has draining wounds or difficulty controlling body 
fluids.
 
In addition to standard and contact precautions, the 
following procedure also may be considered for non-hospital 
healthcare facilities:
 
Patient placement - Place the patient in a private room, if 
possible. When a private room is not available, place the 
patient in a room with a patient who is colonized or infected 
with the same organism, but does not have any other infection 
(cohorting). Another option is to place an infected patient 
with a patient who does not have risk factors for infection. 
 
This organization will consult with state or local health 
departments regarding discharge requirements for patients 
with MRSA or VRE. 
 
Recommendations for pre-admission screening in non-hospital 
settings
The CDC does not have recommendations for pre-admission 
screening.  However, the following options may be considered :
ï    Do NOT perform screening 
ï    Screen high-risk patients on admission (Some evidence from 
a multi-center study suggests that screening before transfer 
 
leads to increased isolation and decreased transmission of 
VRE). 
 
Should clusters or outbreaks of infections occur this 
organization will consult with state or local health 
departments or an experienced infection control professional 
for reporting requirements and management of MRSA or VRE 
outbreaks. 
 
 Outside of healthcare settings, there is little risk of 
transmitting organisms to persons at risk of disease from 
MRSA / VRE; therefore, healthy people are at low risk of 
getting infected. In the home, the following precautions 
should be followed: 
 
ï  Caregivers should wash their hands with soap and 
   water after physical contact with the infected or 
   colonized person and before leaving the home. 
ï  Towels used for drying hands after contact should be used 
   only once. 
ï  Disposable gloves should be worn if contact with body 
   fluids is expected and hands should be washed after 
   removing the gloves. 
ï  Linens should be changed and washed if they are soiled 
   and on a routine basis. 
ï  The patient's environment should be cleaned routinely and 
   when soiled with body fluids. 
ï  Notify doctors and other healthcare personnel who provide
   care for the patient that the patient is ionized/infected 
   with a multidrug-resistant organism. 

Approved By Governing Board    
MC.15
Control #359.0
GUPTA GASTRO