Isolation and Modified Contact Precautions Exercise for MDROs

1. Isolation and Modified Contact Precautions Exercise for MDROs Division of Infectious Disease Epidemiology Office of Epidemiology and Prevention Services

2. Objectives • Familiarize participants with CDC MDRO guidelines for patient placement • Discuss advantages and disadvantages of placement choices • Discuss appropriate placement of hand sanitizer in a facility Division of Infectious Disease Epidemiology Office of Epidemiology and Prevention Services

3. Choices for Placement • Private room • Cohort with roommate with same MDRO • highest priority to those patients who have uncontained secretions or excretions • Place with non-colonized roommate IF: • Roommate has NO immunosuppression or broken skin or indwelling lines or renal failure AND • Both roommates can wash hands AND • No draining wound AND • VRE or MDRGNB patient DOES NOT HAVE urinary or fecal incontinence Division of Infectious Disease Epidemiology Office of Epidemiology and Prevention Services

4. What is the risk of transmission FROM this patient? • 85 year old with a history of MRSA and: • No active infection • No acute medical problems • Indwelling central line s/p cancer chemotherapy • Able to wash hands on request Division of Infectious Disease Epidemiology Office of Epidemiology and Prevention Services

5. What is the risk of transmission TO this patient? • 85 year old with: • No active infection • No acute medical problems • Indwelling central line s/p cancer chemotherapy • Able to wash hands on request Division of Infectious Disease Epidemiology Office of Epidemiology and Prevention Services

6. What is the risk of transmission from this patient? • 85 year old with: • History of CRE • History of MRSA • Diarrhea due to Clostridium difficile Division of Infectious Disease Epidemiology Office of Epidemiology and Prevention Services

7. What is the risk of transmission to this patient? • 75 year old • Hypertension and CAD • s/p total knee replacement • Admitted for rehabilitation Division of Infectious Disease Epidemiology Office of Epidemiology and Prevention Services

8. Modified Contact Precautions • Healthy residents: • Standard precautions • Gloves and gowns for contact with: • uncontrolled secretions, • pressure ulcers, • draining wounds, • stool incontinence and • ostomy tubes/bags • Residents dependent on staff for health and activities of daily living: contact precautions. Division of Infectious Disease Epidemiology Office of Epidemiology and Prevention Services

9. Modified Contact Precautions (2) • PRIVATE ROOM OR COHORT • GLOVES • Touching the patient’s intact skin • Touching surfaces and articles in close proximity to the patient.  • Don gloves upon entry into the room. • GOWN • Clothing will have direct contact with the patient • Clothing will have contact with environmental surfaces or equipment in close proximity to the patient.  • Don gown upon entry into the room.   • Remove gown / gloves and observe HH before leaving the patient-care environment.  Division of Infectious Disease Epidemiology Office of Epidemiology and Prevention Services

10. Duration of Contact Precautions • Outbreak setting: continue contact precautions indefinitely for colonized and infected persons. Division of Infectious Disease Epidemiology Office of Epidemiology and Prevention Services

11. Duration of Contact Precautions (2) • Non-outbreak setting: after antibiotics are discontinued for several weeks AND • the patient does not have a draining wound or uncontained secretions AND • there is no evidence of ongoing transmission in the facility AND • 3 surveillance cultures one week apart are negative, contact precautions may be discontinued. Division of Infectious Disease Epidemiology Office of Epidemiology and Prevention Services

12. ‘Rules’ • Distribute 4 cards (patients) to each person. Place the remaining cards in a pile. Roll dice to determine who goes first. • Follow the ‘Modified contact precautions’ guidelines to ‘place’ one patient during your turn. “Place” a patient by putting the card on an open bed. • If you cannot ‘place’ a patient because all beds are full, roll the dice to identify the room (1-6), and flip a coin (heads = ‘window’ and tails = ‘hallway’) to identify the bed. The ‘patient’ in that bed is then removed and placed on the bottom of the pile. • If you do not have a suitable patient in your hand, draw from the pile until you find a patient appropriate for placement in the available bed(s). • Place hand hygiene dispensers appropriately. Division of Infectious Disease Epidemiology Office of Epidemiology and Prevention Services

13. Discussion Division of Infectious Disease Epidemiology Office of Epidemiology and Prevention Services

14. Questions for Discussion • Did you run into any challenges in placing patients? • How would you resolve those challenges in your own facility? • What particular problems were created by the shared bathrooms? • How did you handle the C diff patients? • Will you change anything in your own facilities based on what you learned from this exercise? • Where did you put the HH dispensers? Division of Infectious Disease Epidemiology Office of Epidemiology and Prevention Services