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Isolation Precautions for MDROs
Isolation Precautions for MDROs
Isolation Precautions for MDROs
Isolation Precautions for MDROs
Isolation Precautions for MDROs
Isolation Precautions for MDROs
Isolation Precautions for MDROs
Isolation Precautions for MDROs
Isolation Precautions for MDROs
Isolation Precautions for MDROs
Isolation Precautions for MDROs
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Isolation Precautions for MDROs

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Isolation Precautions for Multi-Drug Resistant Organisms

Isolation Precautions for Multi-Drug Resistant Organisms

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  • 1. Isolation P recautions for Preventing T ransmission of MDROs Anuj Sharma Senior Consultant Clinical Microbiology Sir Ganga Ram Hospital
  • 2. MDROs <ul><li>Microorganisms – predominantly bacteria – that are resistant to one or more classes of antimicrobial agents </li></ul><ul><li>MRSA, VRE, MDRGNB (+ESBL), MDRSP, VISA, VRSA </li></ul><ul><li>Usually R to all except few ABs – epidemiologically important </li></ul><ul><ul><li>Acinetobacter, Burkholderia cepacia, Klebsiella, Enterobacter, Pseudomonas aeruginosa, </li></ul></ul><ul><li>Transmission </li></ul><ul><ul><li>Same routes as antimicrobial S organisms </li></ul></ul><ul><ul><li>Patient-to-patient transmission, usually via hands of HCWs, especially for MRSA and VRE </li></ul></ul>
  • 3. MDROs <ul><li>Progressive increase esp. in acute care settings </li></ul><ul><li>Prevalence variation - geographic, institutional, patient care unit, temporal </li></ul><ul><li>Impact variation </li></ul><ul><ul><li>Colonisation , infection >> treatment (more difficult & prolonged) L o S, morbidity, mortality, cost </li></ul></ul><ul><li>Relationship to antimicrobial exposure, especially for GNBs </li></ul>
  • 4. MDRO Control <ul><li>Standard / Contact precautions </li></ul><ul><li>Strategies </li></ul><ul><ul><li>Infection prevention </li></ul></ul><ul><ul><li>Accurate / prompt diagnosis & treatment </li></ul></ul><ul><ul><li>Prudent use of ABs </li></ul></ul><ul><ul><li>Prevention of transmission </li></ul></ul>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 <ul><li>Two- tiered approach </li></ul><ul><ul><li>First Tier : Baseline activities for all settings </li></ul></ul><ul><ul><li>Second Tier : More intense and focused control efforts </li></ul></ul><ul><li>Triggers to escalate to second tier </li></ul><ul><ul><li>MDRO identification in high - risk patients or unit </li></ul></ul><ul><ul><li>Failure to reduce MDRO despite first tier efforts </li></ul></ul>
  • 6. Pg 73
  • 7. Pg 74
  • 8. Control interventions <ul><li>Administrative measures </li></ul><ul><li>MDRO education </li></ul><ul><li>Judicious use of antimicrobials </li></ul><ul><li>Surveillance </li></ul><ul><li>Infection control precautions </li></ul><ul><li>Environmental measures </li></ul><ul><li>Decolonisation </li></ul>
  • 9. Top 4 control measures <ul><li>MRSA </li></ul><ul><ul><li>Surveillance cultures of patients </li></ul></ul><ul><ul><li>Contact precautions </li></ul></ul><ul><ul><li>Decolonisation </li></ul></ul><ul><ul><li>Hand hygiene </li></ul></ul><ul><li>VRE </li></ul><ul><ul><li>Surveillance cultures of patients </li></ul></ul><ul><ul><li>Contac t precautions </li></ul></ul><ul><ul><li>Extra cleaning and disinfection </li></ul></ul><ul><ul><li>Education of staff, patients or visitors </li></ul></ul><ul><li>MDR GNB </li></ul><ul><ul><li>Contact precautions </li></ul></ul><ul><ul><li>Surveillance cultures </li></ul></ul><ul><ul><li>Education of staff, patients or visitors </li></ul></ul><ul><ul><li>Hand hygiene </li></ul></ul>
  • 10. Isolation guidelines <ul><li>Contact precautions </li></ul><ul><ul><li>Patient placement Category II </li></ul></ul><ul><ul><ul><li>Single pt. room preferred; prioritize for single room based on presence of conditions that facilitate transmission </li></ul></ul></ul><ul><ul><ul><li>Cohort in one room patients with same pathogen, but maintain separation >3 feet, change protective attire, use hand hygiene between different patients </li></ul></ul></ul><ul><ul><li>Don gowns & gloves upon room entry Category IB </li></ul></ul><ul><li>Droplet precautions </li></ul><ul><ul><li>Don surgical mask upon room entry Category IB </li></ul></ul>
  • 11. C linical microbiology lab <ul><li>Antimicrobial ST testing & interpretation </li></ul><ul><li>Surveillance cultures </li></ul><ul><ul><li>Antibiogrammes, MDRO incidence / infection rates </li></ul></ul><ul><ul><li>Colonisation / Infection </li></ul></ul><ul><li>Molecular typing </li></ul><ul><li>Rapid diagnostic tests </li></ul><ul><li>Detection & rapid reporting of MDROs </li></ul><ul><li>QC programme </li></ul><ul><li>Multidisciplinary approach for judicious use of ABs </li></ul>

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