Multi-Drug Resistant Organisms Remain Substantial Threat to Patients

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While the nation is buried in Ebola viral illness and preparation for a possible epidemic, infection prevention professionals continue to focus not only on this newly emerging illness but also the ongoing issue with multi-drug resistant organisms (MDROs) that have plagued mostly institutionalized patients, including residents in the long-term care setting.

Antibiotic resistant organisms, as recently addressed in a Long-Term Living column, "account for roughly 2 million illnesses per year and 23,000 deaths; Clostridium difficile infections result in roughly 250,000 illnesses per year with 14,000 deaths."

These organisms and infections have several consequences, including increased morbidity with the threat of complex treatment that may or may not be successful, increased mortality as evidenced by the thousands of deaths reported annually as a direct result of these acquired organisms and fiscal challenges as facilities and insurance companies face increased costs.

Besides the ongoing challenges that healthcare facilities face, such as compliance with optimal hand hygiene measures and thorough and effective cleaning of the environment and patient or resident placement in appropriate rooms, the most significant contributor to MDRO acquisition is the injudicious use of antimicrobial agents, mainly antibiotics seen particularly in the long-term care environment. Clinicians face a difficult decision when caring for elderly patients who may be in the process of converting from colonization (the organism is found in the body but not causing illness or disease) to infection (presence of signs and symptoms of disease or illness): when to treat with antibiotics and when to hold off.

The key to preventing the acquisition of MDROs or their spread includes a multidisciplinary approach with input from several departments in a hospital or long-term care facility. In addition to internal efforts by facilities, The Centers for Medicare & Medicaid Services (CMS) requires all facilities document some form of antimicrobial stewardship as part of their infection prevention program.

Phenelle Segal, RN, CIC, FAPIC

Phenelle Segal, RN, CIC, FAPIC, is the founder and president of Infection Control Consulting Services LLC (ICCS). Phenelle has more than 30 years' experience providing customized comprehensive infection control and prevention services to healthcare facilities nationwide. Her services focus on assisting hospitals, ambulatory surgery centers, dental office and oral surgery practices, doctor's offices, nursing homes and other organizations with implementing and maintaining an infection control program that: complies with The Joint Commission, AAAHC, Centers for Medicaid and Medicare Services (CMS) and other regulatory agencies; respond to situations of noncompliance; and improve the processes for reducing risk.