Are you taking the right precautions against bad bugs?
Martha Barstow, RN
Director, Regional Infection Prevention and Accreditation
April 16, 2014
Providence is making great strides in preventing hospital-acquired infections, but multidrug-resistant organisms remain our biggest challenge. The Joint Commission – and Providence's own infection-prevention policies – require providers to know how to prevent transmitting these resistant bugs.
As a reminder, multidrug-resistant organisms include:
- Methicillin-resistant staphylococcus aureus (MRSA)
- Vancomycin-resistant enterococci (VRE)
- Extended spectrum beta-lactamase-producing organisms (ESBL), such as E. coli or klebsiella
- Carbapenem-resistant enterobacteriaceae (CRE)
- Clostridium difficile. Although C. difficile is technically not a multidrug-resistant organism, it poses similar challenges in preventing transmission and for treatment.
MDRO infections are particularly problematic to treat in certain patients with immunosuppression; or those with prosthetic devices or other medical devices, such as central lines, Foley catheters or ventilators.
Transmission-prevention strategies include:
Hand hygiene. Cleanse your hands before and after contact with a patient, even if gloves are worn, or after contact with patient environment. Wash with soap and water, particularly for enteric precautions, or use hand gel.
Isolation precautions. The Epic banner displays MDRO status on patients with a history of those organisms. No physician order is required for precautions.
- Heed modified contact (glove only) precautions with patients who have a history of MDRO but no active infections.
- Contact precautions are used for MDRO patients with active infection or uncontained secretions.
- Because of the concern for CRE virulence, full contact precautions (glove and gown) are required for patients with active or a history of CRE infection. CRE patients also warrant limiting the number of caregivers in contact with the patient.
- Contact enteric precautions (glove and gown) are required for C. difficile and any gastroenteritis symptoms with unknown etiology.
- Equipment, such as stethoscopes, should be wiped down when leaving patient rooms in all contact precautions. It is best practice to disinfect stethoscopes between any patient use.
Of course, standard precautions are used for every patient encounter. If you believe you’ll come in contact with blood or body fluid, you must wear the appropriate protection. This could include gowns, gloves, or eye and face protection. Thank you for your part in preventing infection. For questions, please contact your facility’s infection prevention office.