Author Topic: Prevention & Management DEADLY Multi-Resistant Organisms (MRO)  (Read 5676 times)

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Offline Bhersi

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Healthcare associated infections (HAI) remain a major cause of morbidity, mortality and
excess healthcare costs. HAI contribute a considerable cost to the health care system, as
well as to patients and their families with prolonged hospital stays, readmissions and
additional diagnostic tests and treatment.

(The factors that have likely contributed to these high rates include)
 
excessive and inappropriate use of antibiotics during the last four decades
• behavioural factors eg. poor compliance with hand hygiene
• an increased use of indwelling devices and medical interventions that breach a
patient’s normal bodily defences
• a higher proportion of vulnerable patients
• organisational factors eg. high bed occupancy, increased movement of patients
across geographical areas
• structural issues within HCF eg. access to single rooms and hand basins
• environmental conditions eg. variable cleaning standards.




Measures to control the emergence and transmission of multi-resistant organisms

(MROs) are necessary and beneficial to patients and healthcare facilities (HCF). Public
Health Organisations (PHO) must ensure that appropriate infection prevention and
management strategies are implemented, evaluated for effectiveness and modified to
ensure that there is a consistent decrease in the incidence of all MROs, particularly
methicillin-resistant Staphylococcus aureus (MRSA). The principles and practices can
also be applied to the prevention and management of other MROs such as vancomycin
resistant enterococci (VRE) and multi-resistant Acinetobacter baumannii (MRAB).

RATIONALE

MROs can cause serious illness and avoidable deaths in patients. Reservoirs of MROs
include patients and occasionally healthcare workers (HCW) who are colonised or
infected, and contaminated objects or surfaces in the environment. MROs are often
inadvertently transmitted on the hands of HCW. There is no single factor to explain the
high rates of MRO infections and colonisations, particularly MRSA.
The factors that have likely contributed to these high rates include:
• excessive and inappropriate use of antibiotics during the last four decades
• behavioural factors eg. poor compliance with hand hygiene
• an increased use of indwelling devices and medical interventions that breach a
patient’s normal bodily defences
• a higher proportion of vulnerable patients
• organisational factors eg. high bed occupancy, increased movement of patients
across geographical areas
• structural issues within HCF eg. access to single rooms and hand basins
• environmental conditions eg. variable cleaning standards.

[Infection control measures]

Hand hygiene

Hand hygiene is the single most important practice to reduce the transmission of MRO in
HCF.

HAND HYGEINE

• handwashing with running water and either plain (non-active) or antisepticcontaining
(active) liquid soap; or
• the use of water-free skin cleansers or antiseptics such as alcohol-based
products.
Standard and Contact Precautions must be followed when in direct contact with a patient
who is infected or colonised with an MRO.

In circumstances where an MRO may be transmitted by another route, eg. patients with
MRSA pneumonia, Droplet Precautions must be used to prevent the transmission of the
organism.
Contact Precautions must be used when handling bodies that are known or suspected to
have been infected or colonised with an MRO. Contact Precautions should be maintained
until the body is completely “sealed” (wrapped or body bag) for transport

[Antibiotic usage]
Usage of restricted antibiotic agents should be monitored regularly using defined-daily
doses/1000 patient-days. Usage data should be stratified to identify areas of high (over)
usage. ICU/HDU usage should be evaluated separately.
Proactive drug utilisation evaluation (DUE) studies of antibiotic use should be undertaken
in areas of heavy antibiotic use. Information on DUE can be accessed at


M icrobiology guides therapy wherever possible
I ndications should be evidence based
N arrowest spectrum required
D osage appropriate to the site and type of injection
M inimise duration of therapy
E nsure monotherapy in most situations

 More information: (Infection Control Practitioner (balqis_suad@hotmail.com)





 

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