Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006
Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006 [PDF 233 KB] available for download.
Table 1. Categorization of Reports about Control of MDROs in Healthcare Settings, 1982- 2005
| MDRO | MDR-GNB | MRSA | VRE |
|---|---|---|---|
| No. of Studies Reviewed/category | 30 | 35 | 39 |
| Types of Healthcare Facilities from which Study or Report Arose | |||
| No. (%) from academic facilitiesα | 30 (100) | 28 (80) | 33 (85) |
| No. (%) from other hospitals | 0 | 4 (11) | 3 (85) |
| No. (%) from LTCFs | 0 | 1 (3) | 2 (5) |
| No. (%) from multiple facilities in a region | 0 | 2 (6) | 1 (2) |
| Unit of Study for MDRO Control Efforts | |||
| Special unitβ | 20 | 13 | 19 |
| Hospital | 10 | 19 | 17 |
| LTCF | 0 | 1 | 2 |
| Region | 0 | 2 | 1 |
| Nature of Study or Report on MDRO Controlχ | |||
| Outbreak | 22 | 19 | 28 |
| Non-outbreak | 8 | 16 | 11 |
| Total Period of Observation after Interventions Introduced | |||
| Less than 1 year | 17 | 14 | 25 |
| 1-2 Years | 6 | 6 | 6 |
| 2-5 Years | 5 | 11 | 8 |
| Greater than 5 years | 2 | 4 | |
| Numbers of Control Measures Employed in Outbreaks/Studies | |||
| Range | 2-12 | 0-11 | 1-12 |
| Median | 7 | 7 | 8 |
| Mode | 8 | 7 | 9 |
α Variably described as university hospitals, medical school affiliated hospitals, VA teaching
hospitals, and, to a much lesser extent, community teaching hospitals
β Includes intensive care units, burn units, dialysis units, hematology/oncology units, neonatal
units, neonatal intensive care units, and, in a few instances, individual wards of a hospital
χ Based on authors' description – if they called their experience an outbreak or not; authors
vary in use of term so there is probable overlap between two categories
Table 2. Control Measures for MDROs Employed in Studies Performed in Healthcare Settings, 1982-2005
| Focus of MDRO (No. of Studies) | MDR-GNB (n=30) | MRSA (n=35) | VRE (n=39) |
|---|---|---|---|
No. (%) of Studies Using Control Measure |
|||
| Education of staff, patients or visitors | 19 (63) | 11 (31) | 20 (53) |
| Emphasis on handwashing | 16 (53) | 21 (60) | 9 (23) |
| Use of antiseptics for handwashing | 8 (30) | 12 (36) | 16 (41) |
| Contact Precautions or glove useα | 20 (67) | 27 (77) | 34 (87) |
| Private Rooms | 4 (15) | 10 (28) | 10 (27) |
| Segregation of cases | 4 (15) | 3 (9) | 5 (14) |
| Cohorting of Patients | 11 (37) | 12 (34) | 14 (36) |
| Cohorting of Staff | 2 (7) | 6 (17) | 9 (23) |
| Change in Antimicrobial Use | 12 (41) | 1 (3) | 17 (44) |
| Surveillance cultures of patients | 19 (63) | 34 (97) | 36 (92) |
| Surveillance cultures of staff | 9 (31) | 8 (23) | 7 (19) |
| Environmental cultures | 15 (50) | 14 (42) | 15 (38) |
| Extra cleaning & disinfection | 11 (37) | 7 (21) | 20 (51) |
| Dedicated Equipment | 5 (17) | 0 | 12 (32) |
| Decolonization | 3 (10) | 25 (71) | 4 (11) |
| Ward closure to new admission or to all patients | 6 (21) | 4 (12) | 5 (14) |
| Other miscellaneous measures | 6 (22) β | 9 (27) χ | 17 (44) δ |
α Contact Precautions mentioned specifically, use of gloves with gowns or aprons mentioned,
barrier precautions, strict isolation, all included under this heading
β includes signage, record flagging, unannounced inspections, selective decontamination, and
peer compliance monitoring (1 to 4 studies employing any of these measures)
χ includes requirements for masks, signage, record tracking, alerts, early discharge, and
preventive isolation of new admissions pending results of screening cultures (1 to 4 studies
employing any of these measures)
δ includes computer flags, signage, requirement for mask, one-to-one nursing, changing type of
thermometer used, and change in rounding sequence (1 to 7 studies employing any of these
measures)
References for Tables 1 and 2
MDR-GNBs: (6, 8, 9, 11, 16, 38, 174, 175, 180, 209, 210, 213-215, 218, 334, 388, 406, 407)
MRSA: (68, 89, 152, 153, 165-173, 183, 188, 194, 204, 205, 208, 240, 269, 279, 280, 289, 304,
312, 327, 365, 392, 397, 408-412)
