multidrug resistant organisms (MDRO)

• colonization is when the bacteria lives in the person but no active infection
• MRSA is caused by S. aureus
• the decline in infection rates of MRSA is due to infection control efforts (alcohol based hand rubs, improved hand hygiene)
• risks for MRSA: hospitalization in last 12 months, soft tissue infection, hospitalization in intensive care, and residing in a long term care facility
• transmission of MRSA: direct contact with bacteria can live on surfaces for weeks
• manifestations of MRSA: pneumonia, skin and soft tissue infection, bloodstream infection
• complications of MRSA: osteomyelitis, sepsis -> mods -> death
• VRE is caused by Enterococci
• risk factors of VRE: prolonged hospital stays, immunosuppressed, prolonged exposure to antibiotics, invasive procedures and devices (foreign objects in the body with no blood flow)
• transmission of VRE: direct contact from skin or patient care equipment; lives on surfaces for 7 days and up to 2 months
• manifestations of VRE: UTI, peritonitis, bacteremia, wound infection
• complications of VRE: higher mortality, longer antibiotic therapy, and endocarditis
• VRE infections mostly occur in hospitals and are not associated with community acquisition
• prevalence of VRE is highest among critically ill patients in ICUs
• c diff is the most common cause of antibiotic associated diarrhea
• risk factors for C diff: use of antimicrobials, older than 64, immunosuppression
• transmission of C diff: oral-fecal transmission; on surfaces for months
• manifestations of C diff: positive stool sample, diarrhea (yellow, frothy, foul smelling, liquid)
• if you assume C diff then ISOLATE and then tell provider and ask for an order for isolate and stool culture
• c diff complication: volume depletion (body is trying to rid itself of it and sending all fluid to the gut), renal insufficiency, electrolyte imbalance (low potassium), hypoalbuminemia (due to not absorbing much), peritonitis, paralytic ileus, toxic megacolon, sepsis, DEATH
• treatment for c diff: antibiotics (PO vancomycin); it stays in the GI tract and kills c diff
• patients infected with MDRO are placed on contact isolation precautions
• treatment of MDRO: hand hygiene and isolation
• medication or MRSA: vancomycin IV or orally
• independent interventions for MDRO: isolation and universal precautions, hand hygiene, early mobilization
• educate patients to take all meds until they're gone, hand hygiene, and worsening symptoms (watching for SIRS)
• collaborative interventions for MDRO: cultures of suspected area or bodily fluids (collect even if you dont know if youll need it), medications (antibiotics, pain meds, IV fluids), and wound care (observing strict infection control with PPE)
• key points:

  hand hygiene is always the best; before and after gloving, eating, touching

  monitor patient secretions and vital signs for signs of infection

  when it doubt isolate

  all patients should be assessed using SIRS/MEWS every shift