MDRO (Multiple drug-resistant

organisms)

What You Need to Know

UT Southwestern University Hospitals: Infection Control Department

Multi-drug resistant organisms (MDRO’s) are germs which are not killed by many different antibiotics.

Illness caused by MDROs cannot easily be cured by commonly used medicines.

These germs are easily spread to other people. If a patient becomes sick from a MDRO, they

stay longer in the hospital and are at a higher risk of dying.

What is a Multi-drug Resistant Organism (MDRO)?

MRSA: Methicillin-Resistant Staphylococcus aureus

VRE : Vancomycin-Resistant Enterococcus Multidrug-Resistant (MDR) Acinetobacter Multidrug-Resistant (MDR) Klebsiella Multidrug-Resistant (MDR) Enterobacter Multidrug-Resistant (MDR) Escherichia coli C. Diff: Clostridium difficile

Common MDROs and Their Abbreviations

MDROs are spread from one person to another on the hands.

Hands become soiled when touching the patient to give care or when touching surfaces in the room which the patient or other care givers have touched.

When hands are not washed or gown and gloves are not worn in Contact Isolation rooms, the MDRO is more likely to be passed to another patient.

Hands are the culprits

Panel A: THE MRSA GREW AFTER NO HAND WASHING,

Panel B: AFTER USING ALCOHOL FOAM TO WASH HANDS, NO MRSA GREW

Donskey C and Eckstein B. N Engl J Med 2009;360:e3

WASH YOUR HANDS!

Hand washing is the single most important way to prevent the spread of disease

Use soap and warm water ◦Rub for15 seconds

Alcohol-based products◦Wet hands with foam

and rub in◦99% kill rate◦ It has a persistent

effect, and can continue to kill germs

◦Use 6-8 times before washing with soap & water

WASH YOUR HANDS—IT SAVES LIVES!

Hand HygieneStop the Spread of Germs

Touching the PATIENT isn’t the only way to get germs on your hand!

MDROs live on the surfaces in the room where the patient and other care givers have touched.

Standard Precautions are good hygiene practices which apply to all patients, whether they have a MDRO or not.

Standard Precautions are in effect for all patients, all the time—24 hours/Day, 7 Days/Week.

These include: Washing your hands before and after patient contact If coming in contact with body fluids, as needed,

wear: Gloves Gown Mask Goggles or face shield

How to Protect Your Patients, Yourself, and Your Family:

Standard Precautions

Throw away used sharps promptly.

Any equipment or items in the room which may have been soiled:◦ Clean before using again, or◦ Throw the item away

How to Protect Your Patients, Yourself, and Your Family:

Standard Precautions

How to Know a Patient Has a MDRO

Patients with a known MDRO will be placed in isolation

There are 3 types of isolation:◦ Contact◦ Airborne◦ Droplet

A sign on the door will alert anyone entering the room of the isolation type

Good hand washing is the best way to stop the spread of germs.

Contact Precautions may be added to prevent the bugs from being carried from one room to another on equipment or the hands of care givers.

Contact Precautions

A Green Contact Isolation sign will be on the room door.

Any PERSON entering the room wears gloves and gown, no matter the reason for entering the room or for how long. This includes all staff and visitors.

Contact Isolation Precautions

Contact Isolation Precautions

Remove the gloves and gown and wash hands BEFORE leaving the room.

Equipment from a Contact Isolation room should be cleaned before being used in the care of another patient.

Contact Isolation Precautions Sign

Contact

Sign Color Fluorescent Green

Type of Bug Isolated

MRSA

VRE

Clostridium difficile

Lice

Scabies

Procedure for Isolation

Wash Hands

Don Gown & Gloves BEFORE entering room

REMOVE Gown & Gloves BEFORE leaving room

Wash hands-- Soap & water only if C. diff, otherwise use alcohol foam when leaving room

C. difficile

Sign Color Red Stop Sign

Type of Bug Isolated

Clostridium difficile

Procedure for Isolation

Wash Hands

Don Gown & Gloves BEFORE entering room

REMOVE Gown & Gloves BEFORE leaving room

Wash hands--SOAP & WATER ONLY when leaving roomStop Sign for Clostridium difficile

Contact Precautions+

Use ONLY soap & water to wash hands

Droplet Precautions

A Yellow/Orange Droplet Isolation sign will be on the room door.

Surgical mask required for staff and visitors

Surgical mask for patient if transport out of room required

Droplet

Sign Color Fluorescent Yellow/ Orange

Type of Bug Isolated

RSV

Influenza

Meningitis

Procedure for Isolation

Wash hands

Don Surgical Mask

REMOVE Mask when leaving room

Wash Hands after leaving room with soap & water or alcohol foam

Droplet Isolation Precautions Sign

Airborne A Hot Pink Airborne

Isolation sign will be on the room door.

Negative Pressure Room (318, 319, 426, 566, 567, 718, 719, MSICU - 4 rms)

N95 Mask for staff

Surgical mask for patient if transport out of room required

Duckbill masks for visitors

Airborne

Sign Color Hot Pink

Type of bug Isolated

AFB (Tuberculosis)

Measles

Chicken Pox

(Any staff who have NOT had measles or chicken pox or been vaccinated MAY NOT ENTER patient room.)

Procedure for Isolation

Don N95 mask BEFORE entering room

(Staff must have been fit tested by Occupational Health for appropriate size upon hire.)

Wash Hands

REMOVE Mask when leaving room

Wash Hands after leaving room with soap & water or alcohol foam

Airborne Isolation Precautions Sign

Fact:Patient-to-patient spread of germs can be prevented.

Actions:Use standard precautions Minimize contact with infection-causing body

fluids Use approved airborne/droplet/contact isolation

precautionsWhen in doubt, call infection control

Prevent Spread—What You Can Do

Infection Control has found that patients from Long Term Acute Care (LTAC) facilities usually have a MDRO, either now or in the past

Nursing staff will place them in Contact Isolation immediately upon arrival, no questions asked!

Call Infection Control if you have any questions

Prevent Spread—What You Can Do

Fact: People spread germs from patient to patient.

Actions:Stay home when you are sick Cover your cough or sneeze with a tissueKeep your hands cleanSet an example!

Prevent Spread—What You Can Do

The Infection Control Team

Doramarie Arocha

Gwen Way

David Townson