Isolation Precautions for MDROs

7,064 views

Published on

Isolation Precautions for Multi-Drug Resistant Organisms

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
7,064
On SlideShare
0
From Embeds
0
Number of Embeds
28
Actions
Shares
0
Downloads
0
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Isolation Precautions for MDROs

  1. 1. Isolation P recautions for Preventing T ransmission of MDROs Anuj Sharma Senior Consultant Clinical Microbiology Sir Ganga Ram Hospital
  2. 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. 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. 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. 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. 6. Pg 73
  7. 7. Pg 74
  8. 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. 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. 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. 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>

×