Kingdom of Saudi Arabia ~~I~~I~I
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Oirectorate of Health Affairs in Tabuk ~~ ~I 0_'~ ~WI ~.):l.l.JI
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MULTI-DRUG RESISTANT ORGANISMS (MDRO) MANAGEMENT
IPP-IPC-063 I Infection Prevention and I Medi.cal and Nursing I
Control Department Services 7 May 2018
1.0 PURPOSE:
1.1 This policy outlines the required steps needed to prevent the transmission of multidrug-
resistant microorganisms (MOROs) within and between hospitals.
2.0 DEFINITION:
2.1 MOROs are bacteria that are resistant to many or all available antibiotics.
3.0 POLICY:
3.1 Methicillin-Resistant Staphylococcus Aureus (MRSA) and Vancomycin-Resistant
Enterococci (VRE) are important resistant microorganisms encountered in the hospital;
refer to Methicillin-Resistant Staphylococcus Aureus Management and Vancomycin
Resistant Enterococcus Management.
3.2 Extended Spectrum Beta-Iactamases (ESBLs) and Carbapenem-Resistant
Enterobacteraceae (CRE) are among primary resistant microorganisms of significant
concern in the healthcare setting and are endemic in many hospitals of the GCC countries.
Proper attention to these pathogens is critical to curtail further emergence of these highly
resistant organisms.
3.3 Standard Precautions Must Be Observed For All Patient Care.
4.0 PROCEDURE:
4.1 Notification of the MORO
4.1.1 The microbiology lab will notify the ward and Infection Prevention and Control
(IP&C) Oepartment of the MOROs.
4.1.2 Patients previously discharged MORO positive are flagged and documented by
IPs.
4.1.3 Only IPs can deflag I remove MORO alerts.
4.2 Management of MORO-Positive Patients
4.2.1 Initiate contact precautions in addition to standard precautions.
4.2.2 Patient must be in a single room or can be cohorted with another patient with
the same organism.
4.2.3 MORO-positive patients who are in multi-bed rooms can be managed
temporarily while waiting to be transferred to a Single room or an appropriate
cohort.
4.2.3.1 Place a sign on the cubicle or curtain of the patient's bed.
4.2.3.2 Ensure easy access to PPE and alcohol-based hand rub.
4.2.3.3 Practice strict standard precautions between interactions with
patients in the room.
4.2.3.4 Transfer to a single room or cohort with another patient with the
same organism as soon as possible.
4.2.4 Place a contact isolation sign on the outside of the isolation room door.
4.2.5 Practice strict hand hygiene.
MUL TI DRUG RESISTANT ORGANISMS (MORa) MANAGEMENT
4.2.6 Cohort non-critical items such as stethoscopes and pressure cuffs with the
patient.
4.2.7 Store the minimum amount of supplies in the patient's room.
4.2.8 Use an isolation cart for extra supplies (kept outside the room).
4.2.9 Ensure that all staff understand and comply with the isolation precautions and
hand hygiene protocol.
4.2.10 Limit the patient's activity outside the room to treatments or tests.
4.2.11 Notify receiving departments/wards (e.g., Radiology, Endoscopy, Clinics, OR)
of the patient's isolation status when the patient must be transported for
treatment/tests. Refer to Transporting Patients on Isolation Precautions.
4.2.12 Ensure concurrent and terminal cleaning of the isolation room and equipment
as per house-keeping procedure.
4.2.13 13. Handle/discard contaminated items as per Standard Precautions. Refer
to Standard Precautions.
4.3 Medical
4.3.1 Request Infectious Diseases consultation as needed.
4.3.2 Discharge the patient from the hospital once his/her medical condition allows.
4.3.3 If the patient is being transferred to another hospital or healthcare facility while
still colonized or infected with an MDRO, the transferring hospital is obliged to
inform the receiving hospital of the details of the MDRO in order to ensure
proper isolation. EMS and other healthcare providers involved in transferring
such a patient need to be made aware of the status of the patient and advise
on proper PPE, as well as, disinfection of the ambulance, as deemed
necessary.
4.4 Clearance/Discontinuation of Isolation
4.4.1 Discontinue isolation of MDRO-positive patient after consultation with the IPs.
4.5 Screening of Healthcare Workers (HCWs) and the Environment
4.5.1 Do not screen HCWs or the environment because it is not typically indicated
and incurs unnecessary costs.
4.5.2 IP&C may initiate such measures when indicated.
4.6 Outbreak Management
4.6.1 Management of outbreaks will be coordinated by the IPs and will require the
cooperation of medical, nursing, laboratory and other departments.
4.7 Cleaning of the Patient's Room
4.7.1 Perform regular or terminal cleaning based on Housekeeping.
4.8 Linen
4.8.1 Keep a linen hamper in the isolation area.
5.0 RESPONSIBILITY: (Optional)
5.1 Staff nurse of the respective department.
5.2 Infection Control Practitioners.
5.3 House-keeping.
6.0 REFERRENCE:
6.1 Association for Professionals in Infection Control (APIC) and Epidemiology, Inc. (2014).
Chapter 29: Isolation precautions. In APIC Text of infection control and epidemiology (4th
Ed.)
6.2 2. HICPAC/CDC Guidelines for isolation precautions: preventing transmission of
infectious agents in healthcare setting, 2007.
Page 20f3
MUL TI DRUG RESISTANT ORGANISMS (MDRO) MANAGEMENT
APPROVAL:
Action Name Position Signature Date
Process Owner: Department of Infection Prevention and
Control /"}
Reviewed by: MR. WALEED OTTAI Director of IPC (_~_., ~·lf·le.
DR. MOHAMMAD MOMINUL Acting Consultant" ~
ISLAM for IPC 1i!.P'
g,'i.'S
MR FAHAD MOHAMED AL Director
Reviewed by: BALAWI Laboratory IT 8~"12oJl
MS. HIND MOHAMED ALAIDAI Nursing Director -~ ts'"'#
MR. SALEM ALATAWI Director of TOM .1'"':'\ ~ lCj -{,{
DR. SALEM AL BALAWI Medical Director ~l ~ C{ tlIf~
Approved by: DR. TARIQ ALI AL BALAWI Hospital Director \ J...-:::::: ~
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REVIEW HISTORY
Name Position Signature Date
3
4
Page 30f3
