East Texas Medical Center

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East Texas Medical Center TylerAnnual
Physician EducationMDRO-Multidrug-Resistant
Organisms-Revised April 2013
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Preventing Multidrug-Resistant Organisms
(MDROs) What the Direct Caregiver Should Know
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ObjectivesUpon completion of this module, the
learner will gt Define Multidrug Resistant
Organisms (MDRO) gt Name 2 MDROs gt State the
type of precautions to be used with all patients
and under what circumstances you would wear
gloves gt Name the type of isolation in which
to place someone with an MDRO
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What are Multi-Drug Resistant Organisms?
(MDROs) MDROs are microorganisms, predominantly
bacteria, that are resistant to one or more
classes of antimicrobial agents Examples of
MDROs (not all inclusive) are Methicillin-resist
ant staphylococcus aureus (MRSA) Vancomycin-interm
ediate staphylococcus aureus (VISA) Vancomycin-res
istant staphylococus aureus (VRSA) Vancomycin-resi
stant enterococcus (VRE) Streptococcus pneumoniae
resistant to penicillin and other broad-spectrum
agents Acinetobacter baumannii Carbapenem-resista
nt Enterobacteriaceae (CRE)
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What are Multi-Drug Resistant Organisms? (MDROs)
Other Examples of MDROs are Some
gram-negative organisms with strains that have
developed the ability to produce ESBL
(extended-spectrum beta-lactamase) which is an
enzyme that inactivates beta-lactam antibiotics
such as the penicillins and cephalasporins Klebsi
ella pneumonia Escherichia coli (E.
Coli) Acinetobacter baumannii Stenotrophomonas
maltophilia
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Why Concern over MDRO Infections? MDROs cause
serious, difficult-to-treat infections that can
result in substantial morbidity, mortality,
increased lengths of stay and excess cost. gt
Frequently preventable gt Usually acquired via
transmission by caregiver-to-patient,
environment-to-patient, or patient-to-patient. gt
Judicious use of antimicrobials may decrease
incidence of microorganisms developing antibiotic
resistance.
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What Measures Can We Take to Prevent Transmission
of MDROs? Hand Hygiene (Hand hygiene. A
general term that applies to hand washing using a
antiseptic handwash, antiseptic hand rub, or
surgical hand antisepsis.) The Most
Important Way to Prevent Transmission of
Microorganisms and Infection
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What Other Measures Can We Take to Prevent
Transmission of MDROs? gt Isolation
Precautions gt Follow Standard Precautions
during all patient encounters in all settings in
which healthcare is delivered. gt Remember
Standard Precautions is using appropriate
personal protection equipment (PPE) to protect
against exposure to body fluids Gloves, gown,
mask and eye protection according to assessed
risk of exposure
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What Other Measures Can We Take to Prevent
Transmission of MDROs? Isolation
Precautions Develop and utilize systems to
identify patients with MDROs and notify Infection
Preventionists, physicians and direct
caregivers Place patients with a confirmed MDRO
or history of an MDRO in single-patient
rooms. Group patients with the same MDRO in
designated areas if single-patient room
unavailable.
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What Other Measures Can We Take to Prevent
Transmission of MDROs? Isolation
Precautions Implement Contact Precautions
immediately for all patients infected with MDROs,
that have a previously identified MDRO or have a
history of being colonized with target MDROs
(Implementation of isolation is a nursing order .
It does not require a doctors order.) Notify
Infection Prevention and Control after placing
the patient in isolation
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What Other Measures Can We Take to Prevent
Transmission of MDROs? Contact Precautions
Perform hand hygiene before donning personal
protective equipment (PPE gown and
gloves) Gown and gloves worn upon entering
room Use eye/face protection if risk of
splatter/splash is anticipated (e.g., patient is
coughing or sneezing or has trach) Discard PPE
before leaving room Perform hand hygiene after
discarding PPE
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What Other Measures Can We Take to Prevent
Transmission of MDROs? Isolation
Precautions For MDRO colonized or infected
patients without draining wounds, or uncontrolled
secretions, establish ranges of permitted
ambulation, socialization, and use of common
areas Consult Infection Prevention Control
prior to discontinuing isolation on a patient
even if a physician has written an order for
such
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What Measures Can We Take to Prevent Transmission
of MDROs? Environmental Measures Clean and
disinfect high-touch surfaces (eg bedrails,
faucet handles, door knobs) and equipment used
in the patients environment that may be
contaminated with pathogens Dedicate
noncritical medical items for use on patients
known to be infected or colonized with an MDRO
- Infected organisms present, tissue invasion
and symptoms are present Colonized organisms
present, but no tissue invasion and patient is
asymptomatic
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What Other Measures do Hospitals Take to Prevent
Development of MDROs? Judicious use of
Antimicrobial agents Monitoring appropriate use
of antimicrobial agents Periodic development and
distribution of antibiograms Educating
clinicians regarding appropriate prescribing of
antimicrobial agents
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In Summary Prevention of MDROs Hand
Hygiene, Hand Hygiene, Hand Hygiene Isolation
Precautions Standard Precautions for all
patients Contact Precautions for patients
identified as having an MDRO Environmental
Measures Judicious use of Antimicrobial agents
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Antibiogram can be found in the Links of OneChart
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Antibiogram can be found in Links of OneChart
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Reference http//www.cdc.gov/ncidod/dhqp/pdf/ar
/mdroGuideline2006.pdf
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I ___________________certify I have completed
the Annual Education presentation on MDRO
(Multi Drug Resistant Organisms) Print Name
____________________ Sign ______________________ D
ate ___________