Week 9 - Topic 4: MDRO - Prevention

Question 1

What must you ask regarding patient history related to MDROs?

Answer 1

Past medical history: MDROs, exposure, hospitalizations in or out country, antibiotic use

Family history of MDROs

Work/social history: travel (exposure to illness), participation in contact sports, working in healthcare/daycare/etc…

Question 2

When are patients screened for a colonization with MDRO?

Answer 2

• On admission
• During transfer
• When length of stay > 14 days
• During discharge
• During prevalence surveys (ex: outbreak, q6h months)

Could be more than one instance depending on hospital protocol

Question 3

True or False: Most MDRO carriers don’t have symptoms.

Answer 3

True

Question 4

Whose responsibility is it to screen patients for MDRO?

Answer 4

Nurses

Question 5

Apart from previously known sites, where else do you screen for MRSA?

Answer 5

• Nose
• Wounds
• Around device sites
• Foley (urine)
• Trach (sputum)
• Perianal and moist areas (groin, armpit, under the breast)

Question 6

Why do you screen for MRSA on foleys and trachs?

Answer 6

Because MRSA like to bind to plastic and create a biofilm around it

Question 7

Apart from previously known sites, where else do you screen for VRE?

Answer 7

• Stool
• Rectal swab
• Wounds

Question 8

Apart from previously known sites, where else do you screen for CRE (ESBL)?

Answer 8

• Stool
• Rectal swab
• Wounds
• Foley

Question 9

When do we screen for CRO?

Answer 9

When a PT has been admitted for >24h in the past year or is transferred from a list of institutions (ex: JGH)

Question 10

What are some actions put in place (4) to prevent MDRO?

Answer 10

1) Flag system to identify previously known colonized patient
2) Placed on Contact precautions (and droplet if PT has clinical sx of resp infection and secretions)
3) Dedicate equipment
4) Daily cleaning of surfaces/equipment

Question 11

True or False: You must change gloves for the same patient between procedures.

Answer 11

True

Question 12

What personal objects can carry MDRO?

Answer 12

Cell phones and paper

Question 13

What kind of infected PT can have outside room privileges?

Answer 13

Compliant patients who have been provided teaching about HH and area they can visit

(Privileges must be documented)

Question 14

When would an infected person not have outside room privileges?

Answer 14

Incontinent
Non-compliant
Wounds cannot be covered
Coughing PT

Question 15

True or False: Decolonization treatment is done for MRSA and VRE.

Answer 15

False, only for MRSA

Question 16

What are decolonization treatments?

Answer 16

1) Local antibiotics: bath with CHG or Physohex + apply Muporicin ointments to nares/wounds
2) Systemic antibiotics: Rifampin and Septra OR Rifampin and Doxycycline
Both have 70-90% success rate

3) Topical decolonization (only 30% success): reduces colonization load and success depends on where the organism is (failure if in gut)

Question 17

True or False: Patients of all ages should get a bath with CHG or Physohex.

Answer 17

False, it is contraindicated for newborns

Question 18

When is topical decolonization used?

Answer 18

It may be used if there is an outbreak on the unit and given to every patient

Question 19

When is decolonization impossible?

Answer 19

• If PT is already on other systemic antibiotics

- If PT has open skin wounds or indwelling devices

Question 20

What is the MRSA Decolonization Protocol?ù

Answer 20

• Inform the family of protocol (clean clothes and new skin products)
• Bathe PT daily with 2-4% CHG
• Change bed linen + clean clothes after bathing
• Request room cleaning of all high touch surfaces before PT returns from bath
• Apply ointment in PT’s nares

Question 21

True or False: Topical use of antiseptics are a decolonization strategy.

Answer 21

False, but they help decrease the load of MRSA-VRE-CRE

Question 22

What must you advise a PT going home with regards to hand washing?

Answer 22

Wash hands…
….after toilette and blowing nose
…..before eating and preparing food

Question 23

What must you advise a PT going home with regards to colonization in the household?

Answer 23

Advise a family physician and challenge the need for antibiotics if no culture has been made.

Question 24

What must you advise a PT going home with regards to environmental cleaning?

Answer 24

Must be done frequently
Change linens weekly or more if soiled, daily when highly contagious particles are in it (diarrhea, vomiting, cold, draining pus)

Question 25

What must you advise a PT going home with regards to daily personal hygiene?

Answer 25

Short nails, perianal care after each BM, clean cloths daily, bathing, appropriate hand hygiene

Question 26

What do you do if you’re a healthcare worker with MDRO?

Answer 26

• Ask advice on limiting transmission from your Dr
• Cover open wounds
• Wash hands frequently + daily showers
• Clean uniform/clothes daily
• Avoid sharing personal items (pens, cigarettes, cups, utensils)
• Clean shared equipment (ex: narcotic keys) by wiping them with disinfectant

Question 27

What can nurses teach others with regards to antibiotic resistance?

Answer 27

• What antibiotic resistance is
• Do not save antibiotics for the next illness
• Do not ask for antibiotics

Question 28

What can nurses teach visitors with regards to hand hygiene?

Answer 28

• Demonstrate hand hygiene techniques
• Advise to keep hands off the portals of entry while caring/visiting
• Wash hands frequently

Question 29

What can nurses teach athletes with regards to preventing MDRO spread?

Answer 29

• Keep wounds covered
• Shower immediately after contact sports
• Shower before using whirlpools
• Disinfect equipment (gym mats/cover)
• Clean uniforms after each use
• Report infections to coach, parents, etc.

Question 30

What are the four factors that result in resistance?

Answer 30

1) Poor culture practices
2) Poor antibiotic stewardship programs
3) Poor hand hygiene practices
4) Poor environmental cleaning programs

Question 31

What are examples of poor antibiotic stewardship programs?

Answer 31

• Treat contaminated cultures
• Treat viral infection with antibiotics
• AB continued when no longer necessary
• Given at the wrong dose/time
• Broad spectrum agents used to treat susceptible bacteria