The CDC defines Multidrug-resistant Organisms (MDRO’s) as microorganisms that have developed resistance to multiple antimicrobial drugs; two MDRO’s we are most familiar with in Long-term Care are MRSA (Methicillin-Resistant Staphylococcus Aureus) and VRE (Vancomycin Resistant Enterococcus). Patients, healthcare workers and visitors are potential sources of MDRO’s. They may be colonized, infected, and unknowingly transmitting resistant organisms to one another.
Colonization is defined as the presence of an organism in or on the body but with no clinical signs and symptoms of infection. Infection is defined as tissue invasion by a microorganism accompanied by positive clinical signs and symptoms.
Since health care workers, patients and family alike, could potentially be unaware they are colonized with Multi-Drug Resistant Organisms, it follows they could easily be transmitted from one person to another. Inadequate hand hygiene is the root cause for transmission of pathogens in Long-Term Care and in all other health care settings as well. Health care workers, patients and visitors must do all they can to interrupt the cycle of transmission by consciously and conscientiously washing their hands.
Multi-drug Resistant organisms are not more virulent than their non-resistant predecessors, but they may be more difficult to treat because they are resistant to many classes of antimicrobials. Reducing exposure to MDRO’s is accomplished by using the same approach to preventing transmission of all pathogens found in health care facilities.
- Use Standard Precautions at all times and Transmission Based Precautions for known or suspected infections. Standard Precautions
- Always practice responsible Hand Hygiene
- Use optimum Room Placement of patients with known infections; co-hort those with like infectious organisms.
- PPE (Personal Protective Equipment) use gloves, gowns and masks appropriately. Give frequent demonstrations on the correct procedures for donning, removing and disposing of PPE, followed by staff return demonstrations. Donning and Removing PPE
Assess patients for group activities. In general, if a patient’s wounds are covered and contained, if they are not exhibiting signs and symptoms of infection, and if they are able to demonstrate responsible hygiene practices, it is usually acceptable for them to leave their room. Check the Policies & Procedures for your facility. Conversely, if wounds cannot be covered and drainage contained, if the patient is confused or unable to engage in good hygiene practices, if they demonstrate clinical signs of infection such as fever, active vomiting/diarrhea or if they are coughing productively, they should remain in their rooms until their signs and symptoms have subsided. Again, review and educate your staff to your facility Policy & Procedures, which should be updated as needed for federal, state and local Standards of Care and Best Practice Guidelines.