CDC Supported Projects

Regional Approaches to Combating the Spread of Multi-drug Resistant Organisms

Multi-drug resistant organisms (MDROs) cause infections that can’t be treated by most known antibiotics. MDROs can spread from patient to patient, from patient to health care worker and from medical facility to medical facility.

Stopping the spread of MDROs saves lives

Ten to fifteen percent of all hospital patients and 65 percent of all nursing home residents are colonized with one or more MDRO, which means the MDRO is in, or on, their body but does not make them sick. While they may not get sick right away, being colonized puts the patient and others around them at a much higher risk for becoming infected later.

Complicating the matter is the common movement of patients between hospitals, nursing homes, other health care facilities and home. This movement provides more opportunity for MDROs to spread to others.

What can be done to stop the spread?

In order to stop the spread of MDROs, we must first prevent the spread of MDROs inside health care facilities, including nursing homes. Health departments should use information on how patients move between facilities in order to coordinate and focus interventions where they will have the most impact.

In the 2015 Vital Signs report, CDC outlined how public health and health care facilities can work together to focus activities, share experiences and connect patient safety efforts happening in their region to prevent the spread of MDROs between facilities. Now, CDC is supporting quality assurance and performance improvement projects targeting highly interconnected health facilities and the use of recommended disinfection interventions. (chlorhexidine bathing and nasal disinfection pdf icon[PDF – 281 KB])

Current CDC Supported Projects

Chicago PROTECT (Providing Regional Organizations with TEchniques to ConTrol MDROs)

Chicago PROTECT logo

The Chicago PROTECT project is a four-year program based out of Chicago, Illinois. It also uses information on how patients move between health care facilities to provide a blueprint for infection control strategy.  This program focuses on reducing the spread of the highly-resistant bug carbapenem-resistant Enterobacteriaceae (CRE), and makes use of an established extensively drug resistant organism (XDRO) patient registry to target use of a bundle of interventions in selected facilities.

The program will:

  • Predict which facilities are likely to get high risk patients using patient transfer data.
  • Have a multi-facility CRE patient alert system.
  • Target interventions in facilities predicted to be higher risk, including patient screening for CRE, contact precautions and cohorting, chlorhexidine soap for bathing pdf icon[PDF – 286 KB], and health care worker education / hand hygiene.
  • Measure the impact of the program on regional spread of CRE.
  • Include a cost-benefit analysis of CRE interventions.

Recently Completed CDC Projects

SHIELD Orange County (Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs)

SHIELD Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs

Local hospitals, long-term acute care hospitals and nursing homes in Orange County, California, recently evaluated a regional intervention using antiseptic soaps for bathing and cleansing the nose. This project involved nearly 40 health care facilities that had patient transfer patterns that made MDRO spread more likely to occur between them. This intervention included:

  • Chlorhexidine antiseptic soap for routine bathing.
  • Iodophor for nasal cleaning.

Part of this project involved studying patient movement patterns to see where patients went when they left a health care facility. Did they go home? Did they go directly to another medical facility? Did they go to another health care facility after a stay at home? Understanding the pattern of movement helped us understand how MDROs spread between patients and facilities, and helped predict which facilities were most likely to see patients who had an MDRO previously. This project demonstrated the effectiveness of the coordinated approach on reducing MDROs in health care settings across the entire community. There were substantial reductions in MDRO prevalence across healthcare settings.

Toolkits for nursing homes, hospitals, and long-term acute care hospitals interested in using antiseptic soaps for bathing and cleansing the nose are found at the UCI Health SHIELD: Eliminating multidrug-resistant organismsexternal icon page.