Page 155 - Registrar Orientation Manual 2016

 Multi drug resistant organisms (MDRO)
Antibiotic resistant organisms are a constant and growing concern within all healthcare settings. Multi gram negative resistant organisms are a continual threat from overseas hospitals.
As of 2 November 2015 the way we manage patients with an MDRO has changed.  Patients with a non-multi MRSA (nmMRSA) that is only resistant to
Flucloxacillin +/- Mupirocin +/- Fucidin AND
 Patients with Extended Spectrum Beta Lactamase – E.coli (ESBL – E.coli)
Will no longer require isolation, and can be managed in a multi bed room without the need for contact precautions. Itt is still clinically important to know that a patient is positive for one of these MDRO’s for appropriate treatment.
 Patients with multi MRSA (mMRSA) – resistant to fluclox and systemic antibiotics
AND
 Patients with ESBL – other i.e. Kleb pneumo, E. cloacae Will continue to require isolation and contact precautions.
Other MDRO’s such as Vancomycin Resistant Enterococci (VRE), Carbapenemase Resistant Enterobacteracae (CRE), Klebsiella pneumoniae Carbapenemase (KPC) or the collective multi resistant gram negatives (MRGN) are present overseas and make their way to our facilities at times.
It is therefore important to ask patients if they have been in an overseas health care facility in the previous 2 years. If this is the case the patient requires isolation, screening for MRSA, ESBL and VRE, and the IPC team need to be made aware of their admission.
For further information please refer to the Management of MDRO procedure
https://intranet.sharepoint.waikato.health.govt.nz/Pages/Policies%20and%20Guidelines/Infecti on-prevention-and-control-policies-and-guidelines.aspx
Patients with an MDRO will have a medical warning and patient alert associated with their NHI, these are visible in iPM and clinical work station (CWS). The Alerts and Warnings card at the front of the current volume of clinical notes will also have information.
There is a procedure for the clearing of patients with a MDRO, please contact the CNS – IPC to discuss if this is appropriate for your patient.
 Antimicrobial stewardship
In order to minimise the occurrence of antibiotic resistant organisms, it is important to have prudent prescribing of antibiotics.
Prescribe to organism sensitivity, therefore take clinical specimens.
The Antimicrobial Handbook is available on the intranet, and the Infectious Diseases physicians (Dr Graham Mills, Dr Paul Huggan, and Dr Erana Gray) or Clinical microbiologist (Dr Chris Mansell) are available to assist with selecting the most appropriate therapy.
 The IPC team
Office – ext. 98113
Vicki Parry (CNM) ext. 23136 Lynne McLeod (CNS) ext. 23020 Lisa Maxwell (CNS) ext. 23411 Siew Ling Ong (CNS) ext. 23284 Jude Young (CNS) ext. 23044