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Preventing and Responding to Multiple

Drug-Resistant Organisms in your Hospital

To prevent and respond to Multi Drug-Resistant Drugs Organisms (MDRO) in your
hospital you must first understand what and MDRO is.
MDRO- Microorganisms, predominately bacteria, that are resistant to one or more
antimicrobial agents.i
The more commonly seen MDROs in the veterinary hospital are Methicillin Resistant
Staphylococcus Aureus (MRSA), Methicillin Resistant Staphylococcus
Psuedintermedius (MRSP) and Extended Spectrum Lactamase Gram Negative
Bacteria (ESBL). These organisms have become drug resistant to antimicrobials due to
their ability to mutate or alter their genes when they have encountered antibiotics.
There are many more MDROs out in the world; fortunately they have not been
commonly seen in veterinary hospitals.
The first thing a veterinary hospital can do to prevent MDROs is to create a defensive
posture towards the spread of any infections agents and nosocomial infections. Make a
policy for all staff to wear gloves with each patient and wash hands between handling
each patient.ii Make sure all staff members understand the proper dilution and proper
contact times of the disinfection agents in your hospital. Ensure each exam room and
kennel is properly cleaned between each use. The addition of a high pressure, high heat
steam cleaner to your regular cleaning efforts is also a good idea. Finally, establish a
protocol for weekly terminal cleaning of your clinic. Terminal cleaning is simply a
planned, detailed cleaning of all surfaces of an area or space including walls, air ducts,
and light fixtures.
Another step each veterinary clinic can take is to exercise due diligence to prevent
bacterial resistance. Due diligence is defined by Merriam- Webster on line as, the care
that a reasonable person exercises to avoid harm to other person or property". When a
bacterial infection is suspected, make sure a culture and sensitivity test is submitted to
your local diagnostic lab. This will tell you not only what bacteria you are fighting, but
also what antibiotics are most appropriate to kill those bacteria. Make sure that the
proper dosage and length of time are prescribed for the patient. Also, make sure that the
client is fully aware of the need to follow the prescription as it is written. A number of
different websites can be shared with clients that have pets affected with an MDRO to
help them understand the process of fighting the bacteria.

Have a plan in place for handling patients with a confirmed MDRO iii. Personal
protection equipment (PPE) should be available for all staff dealing with these patients.
PPE should include fluid resistant gowns, gloves, caps or buffounts, masks, eye
protection and shoe covers. During treatment of these patients make sure enough staff
is available to have a clean person. In other words each person in direct contact with
the patient should be wearing PPE, but have one clean person that can get needed
items from drawers and cabinets if needed. Each patient should be kept in some type of
isolation area for MDROs. Once the patient has been treated or discharge, the areas the
patient has been in should be terminally cleaned with an appropriate disinfectant.
MDROs are here to stay. In fact, it is likely that more bacteria will become drug
resistant in the future. Knowing how respond to this likely hood is the best way to
protect your staff, patients and clinic.

i L. Cavney, B. Jones and K. Ellis, Veterinary infection: Prevention and Control : WileyBlackwell 2012
ii . Portner, DVM, DACVECC, J. Johnson, DVM, DACVECC, Compendium: Continuing
Education for Veterinarians, May 2010
iii J. Portner, DVM, DACVECC, J. Johnson, DVM, DACVECC, Compendium: Continuing
Education for Veterinarians, May 2010