Prevention Strategies

Interim Guidance for Public Health Strategies to Prevent the Spread of Novel or Targeted Multidrug-resistant Organisms (MDROs)

The Prevention Strategies are designed to prevent the spread of novel and targeted MDROs, such as Candida auris, carbapenemase-producing Enterobacterales, Pseudomonas spp., and Acinetobacter. If you are looking for the 2006 Management of Multidrug-Resistant Organisms in Healthcare Settings Guideline, see the Infection Control Website.

This document is for use by state, local, territorial, and tribal health departments to support the development, implementation, and coordination of activities designed to prevent the spread of novel and targeted MDROs across multiple healthcare facilities within a jurisdiction. In contrast to the Interim Guidance for a Public Health Response to Contain Novel or Targeted MDROs, which provides response-driven strategies to contain individual cases as they are identified, this complementary guidance document outlines ongoing, long-term strategies to proactively identify patients/residents infected or colonized with, and reduce transmission of, novel and targeted MDROs across a region.

Public Health Strategies to Prevent the Spread of Novel and Targeted Multidrug-resistant Organisms (MDROs)

Prevention strategies outlined here were informed by published evidence on prevention-focused interventions and mathematical modeling performed at CDC to estimate the relative population benefits for different bundles of prevention interventions.1-3 Strategies included in the guidance are intended to reduce transmission of MDROs at all stages of spread, ranging from before a targeted MDRO is identified in a region, to endemicity. As the relative impact of different prevention activities varies by facility characteristics (e.g., patient/resident acuity and average length of stay) and the stage of MDRO spread, health departments should tailor their prevention activities based on the local epidemiology and available resources to maximize impact.


Summary of the Guidance

Guidance Section I. Preparing to Implement an MDRO Prevention Plan

This section describes preparatory steps to inform development and implementation of an MDRO Prevention Plan. Steps include (1) determining the MDRO(s) that will be the focus of the prevention activities, (2) risk stratifying healthcare facilities within the jurisdiction, (3) prioritizing where to begin implementation, (4) evaluating jurisdictional laboratory capacity and surveillance, and (5) defining outcome and process measures.

  • Step 1 Determine the focus MDROs
  • Step 2 Risk stratifying healthcare facilities within the jurisdiction
  • Step 3 Decide where to begin MDRO Prevention Plan implementation
  • Step 4 Evaluate jurisdictional clinical laboratory surveillance
  • Step 5 Define process and outcome measures

Guidance Section II. Elements of an MDRO Prevention Plan

This section describes the four prevention strategies, (1) providing education, (2) improving general infection prevention and control (IPC) practices, (3) detecting colonized individuals, and (4) facilitating communication. The rationale and recommended activities are provided for each strategy.

  • Overview
  • Strategy 1 Conduct education
  • Strategy 2 Improve infection prevention and control (IPC) practices
  • Strategy 3 Detect colonized individuals
  • Strategy 4 Facilitate communication

Appendix 1 Contains an overview of the sections and their individual components.

Technical Appendix

The technical appendix [PDF – 11 pages] is intended to provide an expanded model description and additional results and conclusions for prioritizing individual intervention components of bundled strategies to prevent the spread of novel and targeted multidrug-resistant organisms (MDROs).

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  2. Ostrowsky BE, Trick WE, Sohn AH, et al. Control of vancomycin-resistant enterococcus in health care facilities in a region. N Engl J Med. May 10 2001;344(19):1427-33. doi:10.1056/NEJM200105103441903
  3. Schwaber MJ, Lev B, Israeli A, et al. Containment of a country-wide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention. Clin Infect Dis. Apr 1 2011;52(7):848-55. doi:10.1093/cid/cir025
  4. Grundmann H, Livermore DM, Giske CG, et al. Carbapenem-non-susceptible Enterobacteriaceae in Europe: conclusions from a meeting of national experts. Euro Surveill. Nov 18 2010;15(46)doi:10.2807/ese.15.46.19711-en
  5. Lee BY, Bartsch SM, Hayden MK, et al. How to Choose Target Facilities in a Region to Implement Carbapenem-resistant Enterobacteriaceae Control Measures. Clin Infect Dis. Feb 1 2021;72(3):438-447. doi:10.1093/cid/ciaa072
  6. Won SY, Munoz-Price LS, Lolans K, et al. Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis. Sep 2011;53(6):532-40. doi:10.1093/cid/cir482
  7. Healthcare Infection Control Practices Advisory Committee. Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings. 2017.,using%20those%20same%20infection%20prevention%20and%20control%20practices [PDF – 1 page].
  8. Karmarkar EN, O’Donnell K, Prestel C, et al. Rapid Assessment and Containment of Candida auris Transmission in Postacute Care Settings-Orange County, California, 2019. Ann Intern Med. Nov 2021;174(11):1554-1562. doi:10.7326/M21-2013
  9. Centers for Disease Control and Prevention. Screening for Candida auris Colonization. Updated May 29, 2020. 2022.
  10. Brooks RB, Walters M, Forsberg K, Vaeth E, Woodworth K, Vallabhaneni S. Candida auris in a U.S. Patient with Carbapenemase-Producing Organisms and Recent Hospitalization in Kenya. MMWR Morb Mortal Wkly Rep. Aug 2 2019;68(30):664-666. doi:10.15585/mmwr.mm6830a3
  11. Centers for Disease Control and Prevention. New carbapenem-resistant Enterobacteriaceae warrant additional action by healthcare providers.