Week 9 - Topic 4: MDRO - Prevention Flashcards
What must you ask regarding patient history related to MDROs?
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…
When are patients screened for a colonization with MDRO?
- 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
True or False: Most MDRO carriers don’t have symptoms.
True
Whose responsibility is it to screen patients for MDRO?
Nurses
Apart from previously known sites, where else do you screen for MRSA?
- Nose
- Wounds
- Around device sites
- Foley (urine)
- Trach (sputum)
- Perianal and moist areas (groin, armpit, under the breast)
Why do you screen for MRSA on foleys and trachs?
Because MRSA like to bind to plastic and create a biofilm around it
Apart from previously known sites, where else do you screen for VRE?
- Stool
- Rectal swab
- Wounds
Apart from previously known sites, where else do you screen for CRE (ESBL)?
- Stool
- Rectal swab
- Wounds
- Foley
When do we screen for CRO?
When a PT has been admitted for >24h in the past year or is transferred from a list of institutions (ex: JGH)
What are some actions put in place (4) to prevent MDRO?
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
True or False: You must change gloves for the same patient between procedures.
True
What personal objects can carry MDRO?
Cell phones and paper
What kind of infected PT can have outside room privileges?
Compliant patients who have been provided teaching about HH and area they can visit
(Privileges must be documented)
When would an infected person not have outside room privileges?
Incontinent
Non-compliant
Wounds cannot be covered
Coughing PT
True or False: Decolonization treatment is done for MRSA and VRE.
False, only for MRSA
What are decolonization treatments?
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)
True or False: Patients of all ages should get a bath with CHG or Physohex.
False, it is contraindicated for newborns
When is topical decolonization used?
It may be used if there is an outbreak on the unit and given to every patient
When is decolonization impossible?
- If PT is already on other systemic antibiotics
- If PT has open skin wounds or indwelling devices
What is the MRSA Decolonization Protocol?ù
- 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
True or False: Topical use of antiseptics are a decolonization strategy.
False, but they help decrease the load of MRSA-VRE-CRE
What must you advise a PT going home with regards to hand washing?
Wash hands…
….after toilette and blowing nose
…..before eating and preparing food
What must you advise a PT going home with regards to colonization in the household?
Advise a family physician and challenge the need for antibiotics if no culture has been made.
What must you advise a PT going home with regards to environmental cleaning?
Must be done frequently
Change linens weekly or more if soiled, daily when highly contagious particles are in it (diarrhea, vomiting, cold, draining pus)
What must you advise a PT going home with regards to daily personal hygiene?
Short nails, perianal care after each BM, clean cloths daily, bathing, appropriate hand hygiene
What do you do if you’re a healthcare worker with MDRO?
- 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
What can nurses teach others with regards to antibiotic resistance?
- What antibiotic resistance is
- Do not save antibiotics for the next illness
- Do not ask for antibiotics
What can nurses teach visitors with regards to hand hygiene?
- Demonstrate hand hygiene techniques
- Advise to keep hands off the portals of entry while caring/visiting
- Wash hands frequently
What can nurses teach athletes with regards to preventing MDRO spread?
- 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.
What are the four factors that result in resistance?
1) Poor culture practices
2) Poor antibiotic stewardship programs
3) Poor hand hygiene practices
4) Poor environmental cleaning programs
What are examples of poor antibiotic stewardship programs?
- 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
