Clostridium difficile infections tools, evaluating environmental cleaning tools ( ). Isolation Precautions: Preventing. Transmission of Ifnectious Agents in Healthcare Settings, June isolationpdf. Basic Infection Prevention and Control. Disinfection and sterilization(https://www. ).

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The edit does not constitute change to the intent of the recommendations. The renumbering does not constitute change to the intent of the recommendations.

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The interventions presented below have been utilized in various combinations to reduce transmission of MDROs in healthcare facilities. Neither the effectiveness of individual components nor that of specific combinations of control measures has been assessed in controlled trials. Nevertheless, various combinations of control elements selected under the guidance of knowledgeable content experts have repeatedly reduced MDRO transmission rates dhqo a variety of healthcare settings.

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Recommend on Facebook Tweet Ncidkd Compartir. Rank Description Category IA Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, cnidod epidemiologic studies. Category IB Strongly recommended for implementation and supported by some experimental, clinical, or epidemiologic studies and a strong theoretical rationale. Category II Suggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretical rationale.

No recommendation Unresolved issue. Practices for which insufficient evidence or no consensus regarding efficacy exists. On this Page General Recommendations Administrative measures Education and training Judicious use of hov agents Surveillance Infection control precautions Environmental measures Intensified Interventions Indications and approach Administrative measures Educational interventions Judicious crc of antimicrobial agents Surveillance Enhanced infection control precautions Patient admission and placement Enhanced environmental measures Decolonization.

General recommendations for all healthcare settings independent of the prevalence of multidrug resistant organism MDRO infections or the population served. See Table 3, Tier 1. Administrative Measures Recommendation Category V. Make MDRO prevention and control an organizational patient safety priority.

Provide administrative support, and both fiscal and human resources, to prevent and control MDRO transmission within the healthcare organization. In healthcare facilities without expertise for analyzing epidemiologic data, recognizing MDRO problems, or devising effective control strategies e.

Implement systems to communicate information about reportable MDROs [e. Refer to websites for updated requirements of local and state health ncidov. Implement a multidisciplinary process to monitor and improve healthcare personnel HCP adherence to recommended practices for Standard and Contact Precautions.

Implement systems to designate patients known to be colonized or infected with a targeted MDRO and to notify receiving healthcare facilities and personnel prior to transfer of such patients within or between facilities.

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Support participation of the facility or healthcare system in local, regional, and national coalitions to combat emerging or growing MDRO problems. Provide updated feedback at least dqp to healthcare providers and administrators on facility and patient-care-unit trends in MDRO infections. Include information on changes in prevalence or incidence of infection, results of assessments for system failures, and action plans to improve adherence to and effectiveness of recommended infection control practices to prevent MDRO transmission.

Provide education and training on risks and prevention of MDRO transmission during orientation and periodic educational updates for healthcare personnel; include information on organizational experience with MDROs and prevention strategies. Edit [February ] Edit: November 5, Page last updated: April 5, Content source: Strongly recommended for implementation and strongly supported by well-designed experimental, ncidodd, or epidemiologic studies. Strongly recommended for implementation and supported by some experimental, clinical, or epidemiologic studies and a strong theoretical rationale.

Suggested for implementation and supported gv suggestive clinical or epidemiologic studies or a theoretical rationale. In hospitals and LTCFsensure that a multidisciplinary process is in place to review antimicrobial utilization, local susceptibility patterns 36 antibiogramsand antimicrobial agents included in the formulary to foster appropriate antimicrobial use.


Provide clinicians with antimicrobial susceptibility reports and analysis of current trends, updated at least annually, goov guide antimicrobial prescribing practices. In settings that administer antimicrobial agents but have limited electronic communication system infrastructures to implement physician prompts e.

Prepare and distribute reports to prescribers that summarize findings and provide suggestions for improving antimicrobial use. In microbiology laboratoriesuse standardized laboratory methods and follow published guidance for determining antimicrobial ncodod of targeted e.

In hospitals and LTCFsdevelop and implement laboratory protocols for storing isolates of selected MDROs for molecular typing when needed to confirm transmission or delineate the epidemiology of the MDRO within the healthcare setting. In hospitals and LTCFs with special-care units e.

Establish a frequency for preparing summary reports based on volume of clinical isolates, with updates at least annually.

In healthcare organizations that outsource microbiology laboratory services e. Monitor trends in the incidence of target MDROs in the facility over time using appropriate statistical methods to determine whether MDRO rates are decreasing and whether additional interventions are needed. Specify isolate origin i. Establish a baseline e. When possible, distinguish colonization from infection in analysis of these data.

Follow Standard Precautions during all patient encounters in all settings in which healthcare is delivered. Use masks according to Standard Precautions when performing splash-generating procedures e.

Masks are not otherwise recommended for prevention of MDRO transmission from dhwp to healthcare personnel during routine care e. For relatively healthy residents e.

For ill residents e. For MDRO colonized or infected patients without draining wounds, diarrhea, or uncontrolled secretions, establish ranges of permitted ambulation, socialization, and use of common areas based on their risk to other patients and on the ability of the colonized or infected patients to observe proper hand hygiene and other recommended precautions to contain secretions and excretions.

Use Standard Precautions for patients known to be infected or colonized with target MDROs, making sure that gloves and gowns are used for contact with uncontrolled secretions, pressure ulcers, draining wounds, stool incontinence, and ostomy tubes and bags.

Follow Standard Precautions making sure to use gowns and gloves for contact with uncontrolled secretions, pressure ulcers, draining wounds, stool incontinence, and ostomy tubes and bags. Ncidoc the amount of reusable patient-care equipment that is brought into the home of patients infected or colonized with MDROs. When possible, leave patient-care equipment in the home until the patient is discharged from home care services.

If noncritical patient-care equipment e. No recommendation is made for routine use of gloves, gowns, or both to prevent MDRO transmission in ambulatory or home care settings. No recommendation can be made regarding when to discontinue Contact Precautions. See Background for discussion of options. When single-patient rooms are available, assign priority for these rooms to fdc with known or suspected MDRO colonization or infection. Give highest priority to those patients who have conditions that may facilitate transmission, e.

When single-patient rooms are not available, cohort patients with the same MDRO in the same nciodd or patient-care area. When cohorting patients with the same MDRO is not possible, place MDRO patients in rooms with patients who are at low risk for acquisition of MDROs and associated adverse outcomes from infection and are likely to have short lengths of stay. Clean and disinfect surfaces and equipment that may be contaminated with pathogens, including those that are in close proximity to the patient e.

Dedicate noncritical medical items to use on individual patients known to be infected or colonized with MDROs. Prioritize room cleaning of patients on Contact Precautions. Focus on cleaning and disinfecting frequently touched surfaces e. Individualize the selection of control measures according to local considerations. When incidence or prevalence of MDROs are not decreasing despite implementation of and correct adherence to the routine control measures described above, intensify MDRO control efforts by adopting one or more of the interventions described below.


When the first case or outbreak of an epidemiologically important MDRO e. Continue to monitor the incidence of target MDRO infection and colonization after additional interventions are implemented. If rates do not decrease, implement more interventions as needed to reduce MDRO transmission.

Identify persons with experience in infection control and the epidemiology of MDRO, either in house or through outside consultation, for assessment of the local MDRO problem and for the design, implementation, and evaluation of appropriate control measures. Provide necessary leadership, funding, and day-to-day oversight to implement interventions selected.

Involve the governing body and leadership of the healthcare facility or system that have organizational responsibility for this and other infection control efforts.

Evaluate healthcare system factors for their role in creating or perpetuating transmission of MDROs, including: Develop, implement, and monitor action plans to correct system failures. During the process, update healthcare providers and administrators on the progress and effectiveness of the intensified interventions.

Include information on changes in prevalence, rates of infection and colonization; results of assessments and corrective actions for system failures; degrees of adherence to recommended practices; and action plans to improve adherence to recommended infection control practices to prevent MDRO transmission. Intensify the frequency of MDRO educational programs for healthcare personnel, especially those who work in areas in which MDRO rates are not decreasing.

Provide individual or unit-specific feedback when available. Review the role of antimicrobial use in perpetuating the MDRO problem targeted for intensified intervention. Control and improve antimicrobial use as indicated. Antimicrobial agents that may be targeted include vancomycin, third-generation cephalosporins, and anti-anaerobic agents for VRE, third-generation cephalosporins for ESBLs; and quinolones and carbapenems.

Calculate and analyze prevalence and incidence rates of targeted MDRO infection and colonization in populations at risk; when possible, distinguish colonization from infection. Include only one isolate per cxc, not multiple isolates from the same patient, when calculating rates.

Increase the frequency of compiling and monitoring antimicrobial cvc summary reports for a targeted MDRO as indicated by an increase in incidence of infection or colonization with that MDRO. Obtain ASC from areas of skin breakdown and draining wounds. In addition, include ogv following sites according to target MDROs:. Sampling the anterior nares is usually sufficient; throat, endotracheal tube aspirate, percutaneous gastrostomy sites, ccc perirectal or perineal cultures may be added to increase the yield.

Swabs from several sites may be placed in the same selective broth tube prior to transport. Endotracheal tube aspirates or sputum should be cultured if a respiratory tract reservoir is suspected, e. Obtain surveillance cultures for the target MDRO from patients at the time of admission to high-risk areas, e. Repeat point-prevalence culture surveys at routine intervals or at time of patient discharge or transfer until transmission has ceased. If indicated by assessment of the MDRO problem, collect cultures to assess the colonization status of roommates and other patients with substantial exposure to patients with known MDRO infection or colonization.

Obtain cultures of healthcare personnel for target MDRO when there is epidemiologic evidence implicating the healthcare staff member as a source of ongoing transmission. No recommendation is made regarding universal use of gloves, gowns, or dhhqp in ggov units in acute-care hospitals. Implement policies for patient admission and placement as needed to prevent transmission of a problem MDRO.