Frequently Asked Questions

Multidrug-Resistant Organisms in Non-Hospital Healthcare Settings

December 2000

Questions and Answers

What are "non-hospital healthcare settings"?

They refer to residential settings (e.g., long-term care and skilled nursing homes), home care, hemodialysis centers, and physicians' offices. What are multidrug-resistant organisms? They are bacteria and other microorganisms that have developed resistance to antimicrobial drugs. Common examples of these organisms include:

  • MRSA - methicillin/oxacillin-resistant Staphylococcus aureus
  • VRE - vancomycin-resistant enterococci
  • ESBLs - extended-spectrum beta-lactamases (which are resistant to cephalosporins and monobactams)
  • PRSP - penicillin-resistant Streptococcus pneumoniae

Which multidrug-resistant organisms are most commonly seen in non-hospital settings?

MRSA and VRE are the most commonly encountered multidrug-resistant organisms in patients residing in non-hospital healthcare facilities, such as nursing homes and other long-term care facilities. PRSP are more common in patients seeking care in outpatient settings such as physicians' offices and clinics, especially in pediatric settings.


What is the difference between colonization and infection?

COLONIZATION means that the organism is present in or on the body but is not causing illness.

INFECTION means that the organism is present and is causing illness.


What conditions increase the risk of acquiring these organisms?

There are several risk factors for both colonization and infection:

  • severity of illness
  • previous exposure to antimicrobial agents
  • underlying diseases or conditions, particularly:
    • chronic renal disease
    • insulin-dependent diabetes mellitus
    • peripheral vascular disease
    • dermatitis or skin lesions
  • invasive procedures, such as:
    • dialysis
    • presence of invasive devices
    • urinary catheterization
  • repeated contact with the healthcare system
  • previous colonization of by a multidrug-resistant organism
  • advanced age

Should patients colonized or infected with these organisms be admitted to non-hospital healthcare facilities?

Non-hospital healthcare facilities can safely care for and manage these patients by following appropriate infection control practices. In addition, non-hospital healthcare facilities should be aware that persons with MRSA, VRE, and other infections may be protected by the Americans with Disabilities Act or other applicable state or local laws or regulations.


What can be done to prevent or control transmission of these pathogens in my facility?

CDC's recommendations for preventing transmission of MRSA / VRE in hospitals consist of standard precautions, which should be used for all patient care. In addition, CDC recommends contact precautions when the facility (based on national or local regulations) deems the multidrug-resistant microorganism to be of special clinical and epidemiologic significance.

The components of contact precautions may be adapted for use in non-hospital healthcare facilities, especially if the patient has draining wounds or difficulty controlling body fluids.

In addition to standard and contact precautions, the following procedures also may be considered for non-hospital healthcare facilities:

  • Patient placement - Place the patient in a private room, if possible. When a private room is not available, place the patient in a room with a patient who is colonized or infected with the same organism, but does not have any other infection (cohorting). Another option is to place an infected patient with a patient who does not have risk factors for infection.
  • Patient placement in dialysis facilities - Dialyze the patient at a station with as few adjacent stations as possible (e.g., at the end or corner of the unit).
  • Group activities - It is extremely important to maintain the patients' ability to socialize and have access to rehabilitation opportunities. Infected or colonized patients should be permitted to participate in group meals and activities if draining wounds are covered, bodily fluids are contained, and the patients observe good hygienic practices.

The following are recommended for prevention of VRE / MRSA in hospitals and may be adapted for use in non-hospital healthcare facilities:

  • Obtain stool cultures or rectal swab cultures of roommates of patients newly found to be infected or colonized with VRE, and nasal swabs for MRSA.
  • Adopt a policy for deciding when patients can be removed from isolation, e.g., VRE-negative results on at least three consecutive occasions, one or more weeks apart.
  • Consult health departments regarding discharge requirements for patients with MRSA or VRE.


Are there any recommendations for pre-admission screening in non-hospital settings?

CDC does not have recommendations for pre-admission screening.
However, the following options may be considered:

  • Do NOT perform screening
  • Screen high-risk patients on admission
    (Some evidence from a multicenter study suggests that screening before transfer leads to increased isolation and decreased transmission of VRE).


How should clusters or outbreaks of infections be handled?

Consult with state or local health departments or an experienced infection control professional for reporting requirements and management of MRSA or VRE outbreaks.


If a patient in a facility is colonized or infected with MRSA or VRE, what do their visitors/family members need to know?

In general, healthy people are at low risk of getting infected with MRSA or VRE. Therefore, casual contact - such as kissing, hugging, and touching - is acceptable. Visitors should wash their hands before leaving an infected person's room. Also, disposable gloves should be worn if contact with body fluids is expected. (If excessive contact with body fluids is expected, gowns should also be worn.) It is also acceptable for infants and children to have casual contact with these patients.


What precautions should family caregivers take for infected persons in their homes?

Outside of healthcare settings, there is little risk of transmitting organisms to persons at risk of disease from MRSA / VRE, therefore, healthy people are at low risk of getting infected. In the home, the following precautions should be followed:

  • Caregivers should wash their hands with soap and water after physical contact with the infected or colonized person and before leaving the home.
  • Towels used for drying hands after contact should be used only once.
  • Disposable gloves should be worn if contact with body fluids is expected and hands should be washed after removing the gloves.
  • Linens should be changed and washed if they are soiled and on a routine basis.
  • The patient's environment should be cleaned routinely and when soiled with body fluids.
  • Notify doctors and other healthcare personnel who provide care for the patient that the patient is colonized/infected with a multidrug-resistant organism. Top

Additional Reading

Antimicrobial resistance in long-term-care facilities. SHEA 1996 (130KB/12 pages) Leave CDC


Date last modified: August 31, 2004
Content source: 
Division of Healthcare Quality Promotion (DHQP)
National Center for Preparedness, Detection, and Control of Infectious Diseases