Multidrug-Resistant Organisms: An Innovative Approach to Preventing Healthcare Transmission

Purpose:
Preventing the healthcare transmission of multidrug resistant organisms (MDROs) is a continuous process, especially given the uncertainty of the effectiveness of prevention measures. An interdisciplinary team was formed within a community Magnet hospital to reduce MDRO transmission.

Significance:
Incidence and prevalence of multidrug resistant organisms are on the rise nation-wide. Highly resistant organisms such as Klebsiella pneumoniae Carbapenemase (KPC), Methicillin Resistant Staphlococcus aureus (MRSA) and Clostridium difficile (C. diff) are an emergent threat to hospitalized patients.

Strategy and Implementation:
The MDRO Prevention Team was created with interdisciplinary members from nursing, Environmental Services, Pharmacy, Lab and Medical Staff to develop innovative strategies to prevent transmission. Interventions implemented for all MDRO prevention include real-time email alerts to Infection Preventionists, patient/family education, deep dive process to investigate healthcare associated MDRO infections as a multidisciplinary team and evaluation of surface disinfection measured by ultraviolet light technology. In addition, C. diff-specific interventions initiated were a C. diff Bundle, which included a rolling soiled linen cart, bleach-based wipes and Contact Enteric Isolation signs. To address KPCs, Strict Contact Isolation was created which included patient dedicated single-use equipment, discharge cleaning completed twice by different staff and strict compliance with PPE and hand hygiene. Ventilated patients admitted from long term care facilities are placed on Strict Contact Isolation.

Evaluation:
The innovative efforts of the MDRO Team proved successful. The rate of healthcare-associated (HA) MRSA decreased 85% from 2009 to 2011. Community cases of C. diff have steadily increased, however, the HA C. diff rate decreased in 2010 and 2011. Healthcare-associated KPC infections remained at zero.

Implications for Practice:
Implementing Evidence Based Practices to prevent MDROs requires an interdisciplinary approach, with stakeholder buy-in. In addition, MDRO transmission prevention requires innovative thinking from front-line staff to initiate and sustain improvement.