MULTIDRUG RESISTANT ORGANISMS

(MDRO) MANAGEMENT
MULTIDRUG RESISTANT ORGANISMS (MDRO)
MANAGEMENT

PURPOSE
SCOPE
POLICY
PROCEDURE
DEFINITIONS
RELATED POLICIES

ABBREVIATIONS

REFERENCES
ATTACHMENT
 1. Purpose

1.1 To reduce the risk of multidrug resistant organism (MDRO) infection through
screening identified patient/client groups and also the spread of MDRO to other
vulnerable patient/clients.

1.2 To ensure the timely identification, treatment and effective management of

patient found to be MDRO positive and to implement the policy.

1.3 Provide an approach to identification and management of patients/clients

with MDRO.

1.4 Ensure active management of MDRO colonization/infection who fit the

criteria of ‘at risk’ in a number of patient/client groups.
 2. Scope

2.1 This policy describes the steps needed to prevent the spread of multidrug
resistant microorganisms (MDROs) within the hospital.
 3. Policy

3.1 MDROs are bacteria that are resistant to many or all antibiotics.

3.2 Methicillin-resistant Staphylococcus aureus (MRSA) is the primary resistant

microorganism encountered in the hospital; refer to policy A0B0-05-06
“Methicillin-resistant Staphylococcus aureus Management”.

3.3 The emergence of other gram-positive and gram-negative drug-resistant

microorganism on the rise.

3.4 Standard Precautions must be observed for all patient care.

 4. Procedure

Notification of the MDRO

- The microbiology or infection control Practitioner will notify the ward of

the MDRO.

- Patients previously discharged MDRO positive are flagged in MDRO

documentation.
 4. Procedure

Management of MDRO-positive patients

- Initiate contact precautions in addition to standard precautions.

- Patient must be in a single room or can be cohorted with another patient

with the same organism.
 4. Procedure

Management of MDRO-positive patients

-MDRO-positive patients who are in multi-bed rooms can be managed

temporarily while waiting to be transferred to a single room or an
appropriate cohort.
- Place a sign on the cubicle or curtain of the patient’s bed.
- Ensure easy access of PPE and alcohol-based hand rub.
- Practice strict standard precautions between interactions with patients in
the room.
- Transfer to a single room or cohort with another patient with the same
organism as soon as possible.
 4. Procedure

Management of MDRO-positive patients

- Place a contact isolation sign on the outside of the isolation room door.

- Practice strict hand hygiene.

- Cohort non-critical items such as stethoscopes and pressure cuffs with the
patient.

- Store the minimum amount of supplies in the patient’s room.

- Use an isolation cart of extra supplies (kept outside the room).

 4. Procedure

Management of MDRO-positive patients

- Ensure that all staff understand and comply with the isolation precautions and hand
hygiene protocol.

- Limit the patient’s activity outside the room to treatments or tests.

- Notify receiving departments/wards (e.g. Radiology, Endoscopy, Clinics,OR) of the

patient’s isolation status when the patient must be transported for treatments/tests.

- Ensure concurrent and terminal cleaning of the isolation room and

equipment as per housekeeping procedure.

- Handle/discard contaminated items as per Standard Precautions. Refer to

policy A0B0- 04-01 “Standard Precautions”.
 4. Procedure

Medical

- Discharge the patient from the hospital once his/her medical condition allows. Refer
to A0B0-04-02 Transmission Based Precautions.

Clearance/Discontinuation of Isolation.

- Discontinue isolation of MDRO patient as per Physician’s order.

- Notify the Infection Control Unit
 4. Procedure

Screening of healthcare workers (HCWs) and the environment.

- Do not screen HCWs or the environment because it is not typically

indicated and incurs unnecessary costs.

- Infection Control Unit may initiate such measures when indicated.

Screening of healthcare workers (HCWs) and the environment.

- Management of outbreaks will be coordinated by the ICP and will require

the cooperation of medical, nursing, laboratory, and other departments.
 4. Procedure

Cleaning of the patient’s room

 
- Performs regular cleaning as per housekeeping protocol.

Linen

 
- Keep linen hamper in the isolation room.
 5. Definitions

 
MDRO- is a bacterial isolate which is resistant to one or more agents in three or more
different classes of antimicrobials that the isolate is expected to be susceptible to; e.g.
cephalosporins, aminoglycosides, flouroquinolones and carbapenems.
Infection- the presence of MDRO in tissues or body fluid along with signs and
symptoms of infection (either locally or systemically) or the presence or MDRO in
normally sterile body sites or fluids (but not necessarily with systems of infection).
Colonization- the presence of MDROin the body fluids or tissues (e.g. gastrointestinal
tract, urine or sputum) without clinical signs of infection.
Isolation- Placement of patient in a single room with en-suite toilet facilities.
Isolation room- an isolation room indicated for the MDRO discussed in this guidelines
document is a single room with en-suite toilet facilities, including dedicated
washing/bathing facilities for the patient. There should be a separate hand washing sink
and alcohol hand rub dispenser at the entrance of the room.