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Brief Summary

GUIDELINE TITLE

Environmental measures for the prevention and management of multi-drug resistant organisms (MDROs). In: Prevention and control of healthcare-associated infections in Massachusetts.

BIBLIOGRAPHIC SOURCE(S)

  • Environmental measures for the prevention and management of multi-drug resistant organisms (MDROs). In: Betsy Lehman Center for Patient Safety and Medical Error Reduction, JSI Research and Training Institute, Inc. Prevention and control of healthcare-associated infections in Massachusetts. Part 1: final recommendations of the Expert Panel. Boston (MA): Massachusetts Department of Public Health; 2008 Jan 31. p. 54-5.

GUIDELINE STATUS

This is the current release of the guideline.

BRIEF SUMMARY CONTENT

 
RECOMMENDATIONS
 EVIDENCE SUPPORTING THE RECOMMENDATIONS
 IDENTIFYING INFORMATION AND AVAILABILITY
 DISCLAIMER

 Go to the Complete Summary

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

Note from the Massachusetts Department of Public Health (MDPH) and the National Guideline Clearinghouse (NGC): Prevention and Control of Healthcare-Associated Infections in Massachusetts guideline has been divided into individual summaries. In addition to the current summary, the following are available:

Level of evidence ranking (I – V) and strength of recommendation ranking (A – D, Unresolved issue [UI], No recommendation) definitions are presented at the end of "Major Recommendations" field.

Tier 1: General Recommendations for Routine Prevention and Control of Multi-Drug Resistant Organisms (MDROs) in Health Care Settings

  1. Clean and disinfect surfaces and equipment that may be contaminated with pathogens, including those that are in close proximity to the patient (e.g., bed rails, over-bed tables) and frequently touched surfaces in the patient care environment (e.g., door knobs, surfaces in and surrounding toilets in patients' rooms) on a more frequent schedule compared to that for minimal touch surfaces (e.g., horizontal surfaces in waiting rooms). A-IV*
  2. Dedicate non-critical medical items to use on individual patients known to be infected or colonized with MDROs when possible. B-IV*
  3. Focus on cleaning and disinfecting frequently touched surfaces (e.g., bedrails, bedside commodes, bathroom fixtures in the patient's room, doorknobs) and equipment in the immediate vicinity of the patient. A-IV*

Tier 2: Recommendations for Intensified MDRO Control Efforts

Institute one or more of the interventions described below when:

  • Incidence or prevalence of MDROs are not decreasing despite the use of routine control measures
  • The first case or outbreak of an epidemiologically important MDRO is identified within the healthcare facility or unit
  • Continue to monitor the incidence of the target MDRO infection and colonization; if the rates do not decrease, implement additional interventions as needed to reduce MDRO transmission
  1. Implement patient-dedicated use of non-critical equipment. B-IV*
  2. Intensify and reinforce training of environmental staff who work in areas targeted for intensified MDRO control. Some facilities may choose to assign dedicated staff to targeted patient care areas to enhance consistency of proper environmental cleaning and disinfection services. B-IV*
  3. Monitor cleaning performance to ensure consistent cleaning and disinfection of surfaces in close proximity to the patient and those likely to be touched by the patient and healthcare workers (HCWs) (e.g., bedrails, carts, bedside commodes, doorknobs, faucet handles). B-IV*
  4. Obtain environmental cultures (e.g., surfaces, shared equipment) only when epidemiologically implicated in transmission. B-IV*
  5. Vacate units, when possible, for environmental assessment and intensive cleaning when previous efforts to control environmental transmission have failed. B-IV*

*Identifies evidence from the Centers for Disease Control and Prevention (CDC)'s updated guidelines without repeating the detailed literature review process.

Definitions:

Level of Evidence Ranking

Level I: Strong evidence from at least one well-designed randomized controlled trial

Level II: Evidence from well-designed non-randomized trials; cohort or case-controlled analytic studies (preferably from >1 center); multiple time-series studies

Level III: Well-designed descriptive studies from more than one center or research group

Level IV: Opinions of authorities (e.g., guidelines), clinical evidence; reports of expert committees

Level V: No quality studies found and no clear guidance from expert committees, authorities or other sources

Strength of Recommendation Ranking

Category A: Strongly recommended

Category B: Recommended for implementation

Category C: Consider for implementation

Category D: Recommended against implementation

Category UI: Unresolved issue

No recommendation: Unresolved issue. Practices for which insufficient evidence or no consensus regarding efficacy exists.

CLINICAL ALGORITHM(S)

None provided

EVIDENCE SUPPORTING THE RECOMMENDATIONS

TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

IDENTIFYING INFORMATION AND AVAILABILITY

BIBLIOGRAPHIC SOURCE(S)

  • Environmental measures for the prevention and management of multi-drug resistant organisms (MDROs). In: Betsy Lehman Center for Patient Safety and Medical Error Reduction, JSI Research and Training Institute, Inc. Prevention and control of healthcare-associated infections in Massachusetts. Part 1: final recommendations of the Expert Panel. Boston (MA): Massachusetts Department of Public Health; 2008 Jan 31. p. 54-5.

ADAPTATION

DATE RELEASED

2008 Jan 31

GUIDELINE DEVELOPER(S)

Betsy Lehman Center for Patient Safety and Medical Error Reduction - State/Local Government Agency [U.S.]
Massachusetts Department of Public Health - State/Local Government Agency [U.S.]

SOURCE(S) OF FUNDING

Massachusetts Department of Public Health

GUIDELINE COMMITTEE

Massachusetts Healthcare-Associated Infections Expert Panel

COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Panel Members: Richard T. Ellison III, MD (Chair) Hospital Epidemiologist, Professor of Medicine, Molecular Genetics and Microbiology, University of Massachusetts Memorial Medical Center; Mary Ellen Scales, RN, MSN, CIC (Vice-Chair) Manager, Infection Control, Baystate Medical Center; Mary Alexander, RN, Chief Executive Officer, Infusion Nurse's Society; Eric Alper, MD, Internal Medicine, University of Massachusetts Memorial Medical Center; Evie Bain, RN, Occupational Health & Safety, Massachusetts Nurses Association; Anne Baras, RN, Surgical Technology Department Chair, North Shore Community College; Karen Boudreau, MD, Medical Director, Healthcare Quality Improvement, Blue Cross Blue Shield of MA; Ann Marie Bourque, NP, President, New England Chapter of the National Conference of Gerontological Nurse Practitioners; Lou Ann Bruno-Murtha, MD, Medical Director, Infection Control Division Chief, Cambridge Health Alliance; Wanda Carey, RN, BSN, CIC, Manager, Infection Control, Caritas Norwood Hospital; Philip Carling, MD, Director, Infectious Diseases and Hospital Epidemiology, Caritas Carney Hospital; Donald Craven, MD, Chair, Infectious Disease, Lahey Clinic; Jane Foley, RN, Director of Operations, Nursing, Beth Israel-Deaconess Medical Center; Denise Graham, Sr. Director Public Policy, Association for Professionals in Infection Control and Epidemiology; Paula Griswold, MS, Executive Director, Massachusetts Coalition for the Prevention of Medical Errors; David Hooper, MD, Internal Medicine/ID, Massachusetts General Hospital; Linda Kenney, President, Executive Director, Medically Induced Trauma Support Services; Jim Liljestrand, MD, Medical Director, Quality Improvement, MassPro; Michael Mitchell, MD, Director, Microbiology Services, University of Massachusetts Memorial Medical Center; Sharon-Lise Normand, PhD, Professor of Biostatistics, Harvard Medical School; Richard Olans, MD, Director, Infectious Disease, Hallmark Health Hospitals; Gail Potter-Bynoe, BS, CIC, Manager, Infection Control, Children's Hospital Boston; Selwyn Rogers, MD, Division Chief, Trauma, Burns, and Surgical Critical Care, Director, Center for Surgery and Public Health, Assistant Professor of Surgery, Brigham and Women's Hospital; Jeannie Sanborn, RN, MS, CIC, Infection Control Professional Heywood Hospital; Thomas Sandora, MD, Pediatric ID, Children's Hospital Boston; Kenneth Sands, MD, Senior Vice President, Health Care Quality, Beth Israel-Deaconess Medical Center; Christine Schuster, RN, CEO and President, Emerson Hospital; David Smith, MHSA, Senior Director, Health Data Analysis & Research, Massachusetts Hospital Association; Carol Sulis, MD, Hospital Epidemiologist, Associate Professor of Medicine, Boston Medical Center; Thomas Sullivan, MD, Cardiologist in Private Practice, Women's Health Center Cardiology (Danvers)

FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

GUIDELINE STATUS

This is the current release of the guideline.

GUIDELINE AVAILABILITY

AVAILABILITY OF COMPANION DOCUMENTS

PATIENT RESOURCES

None available

NGC STATUS

This NGC summary was completed by ECRI Institute on October 3, 2008. The information was verified by the guideline developer on December 22, 2009.

COPYRIGHT STATEMENT

No copyright restrictions apply.

DISCLAIMER

NGC DISCLAIMER

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Readers with questions regarding guideline content are directed to contact the guideline developer.


 

 

   
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