Management of Multidrug-Resistant Organisms (MDROs) and Outbreak Situations

● Cohorting: In the context of this guideline, this term applies to the practice of grouping patients infected or colonized with the same infectious agent together to confine their care to one area and prevent contact with susceptible patients (cohorting patients). During outbreaks, healthcare personnel may be assigned to a cohort of patients to further limit opportunities for transmission (cohorting staff).

● Contact Precautions: Contact Precautions are a set of practices used to prevent transmission of infectious agents that are spread by direct or indirect contact with the patient or the patient's environment. Contact Precautions also apply where the presence of excessive wound drainage, fecal incontinence, or other discharges from the body suggest an increased transmission risk. A single patient room is preferred for patients who require Contact Precautions. When a single patient room is not available, consultation with infection control is helpful to assess the various risks associated with other patient placement options (e.g., cohorting, keeping the patient with an existing roommate). In multi-patient rooms, ≥1  meter spatial separation of between beds is advised to reduce the opportunities for inadvertent sharing of items between the infected/colonized patient and other patients. Healthcare personnel caring for patients on Contact Precautions wear a gown and gloves for all interactions that may involve contact with the patient or potentially contaminated areas in the patient's environment. Donning of gown and gloves upon room entry, doffing before exiting the patient room and performance of hand hygiene immediately upon exiting are done to contain pathogens.

● Endemic: The constant presence of a disease or infectious agent within a given geographic area or population group, without importation from outside; may also refer to the usual or expected frequency of the disease within such area or population group.

● Epidemic: Epidemic refers to an increase, often sudden, in the number of cases of a disease above what is normally expected in a specific geographical area. Epidemics occur when an agent and susceptible hosts are present in adequate numbers, and the agent can be effectively conveyed from a source to the susceptible hosts. More specifically, an epidemic may result from:

−  A recent increase in the amount or virulence of the agent,

−  The recent introduction of the agent into a setting where it has not been before,

−  An enhanced mode of transmission so that more susceptible persons are exposed,

−  A change in the susceptibility of the host response to the agent, and/or

−  Factors that increase host exposure or involve introduction through new portals of entry.

● Hand hygiene: A general term that applies to any one of the following:

− Handwashing with plain (non-antimicrobial) soap and water);

−  Antiseptic hand rub (waterless antiseptic product, most often alcohol-based, rubbed on all surfaces of hands); or

−  Surgical hand antisepsis (antiseptic hand wash or antiseptic hand rub performed preoperatively by surgical personnel to eliminate transient hand flora and reduce resident hand flora).

● Healthcare-associated infection (HAI): An infection that develops in a patient who is cared for in any setting where healthcare is delivered (e.g., acute care hospital, chronic care facility, ambulatory clinic, dialysis center, surgy center, long term home care) and is related to receiving health care (i.e., was not incubating or present at the time healthcare was provided). In ambulatory and home settings, HAI would apply to any infection that is associated with a medical or surgical intervention performed in those settings.

● Healthcare personnel (HCP): All paid and unpaid persons who work in a healthcare setting, also known as healthcare workers (e.g. any person who has professional or technical training in a healthcare-related field and provides patient care in a healthcare setting or any person who provides services that support the delivery of healthcare such as dietary, housekeeping, engineering, maintenance personnel).

● MDRO: For epidemiologic purposes, MDROs are defined as microorganisms, predominantly bacteria, that are resistant to one or more classes of antimicrobial agents. Although the names of certain MDROs describe resistance to only one agent (e.g., MRSA, VRE), these pathogens are frequently resistant to most available antimicrobial agents. These highly resistant organisms deserve special attention in healthcare facilities. In addition to MRSA and VRE, certain GNB, including those producing extended spectrum beta-lactamases (ESBLs) and others that are resistant to multiple classes of antimicrobial agents, are of particular concern.

● Outbreak: Outbreak carries the same definition of epidemic but is often used for a more limited geographic area. An outbreak is the occurrence of more cases of disease than expected in a given area or among a specific group of people over a particular period of time. Usually, the cases are presumed to have a common cause or to be related to one another in some way.

● Personal protective equipment (PPE): Specialized clothing or equipment worn by an employee for protection against a hazard. General work clothes (e.g., uniforms, pants, shirts) not intended to function as protection against a hazard are not considered to be PPE.