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Newsletter       Vol. 4, No. 3 July 1996

Guidelines for the Screening of Multiply Drug Resistant Organisms (MDROs) for Patients who have been Hospitalized Out-of-Country

Multiply drug resistant organisms (MDROs) may be simply defined as organisms which have become resistant to the drugs which are usually employed to treat infections with that organism. They are not more virulent or more easily transmissible but the usual antibiotics are no longer effective. MDROs may cause infection if they enter normally sterile sites such as blood, urine and tissue. The patients most at risk of infection are those with compromised host defences including patients with cancer, transplants, burns, indwelling devices, dialysis and patients in critical care units.

To date, the Canadian health care system has not encountered MDROs to the extent seen in the United States or Europe but they are nonetheless being seen with increasing frequency. Because of the acknowledged higher risk of carriage of MDROs from patients who have been hospitalized outside of Canada the following policy has been implemented at The Toronto Hospital to prevent inapparent transmission of MDROs.

Background and Purpose:

MDROs such as vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) have become endemic in many countries, and represent a significant challenge to patients in Canadian hospitals, placing additional pressure on health care resources. It is hoped that by implementing a protocol of routine culturing of patients considered at high risk of carriage, MDROs will be recognized on admission so that appropriate infection control measures may be implemented.

Guidelines:

  1. Infection Control is to be notified whenever the following patients have been admitted:

    • any patient who has been transferred from healthcare facility outside of Canada
    • any patient who has been transferred from any healthcare facility or jurisdiction within Canada where a current outbreak has been identified

  2. Isolation precautions may be discontinued when the results of the cultures are known to be negative.

Policy:

Patients who have been transferred from a health care facility outside of Canada, or have been transferred from a Canadian healthcare facility or other jurisdiction where a known outbreak has been identified, are to have appropriate cultures taken on admission to rule out colonization or infection with a MDRO. These patients should also be admitted to a single room, with gown and glove precautions taken until the results of the cultures are known at 24-48 hours.

The following screening cultures are to be taken:

VRE: peri-rectal swab (be sure to enter r/o VRE in the comment field)

MRSA: nasal, axilla, groin and wound swabs (be sure to enter r/o MRSA in the comment field)

Other MDROs: Wound/sputum/peri-rectal swabs as appropriate


References:

  1. Recommendations for preventing the spread of vancomycin-resistance: Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). Am J Infect Contr 1995;23:87-94.
  2. Patterson J, et al. Special organism isolation: Attempting to bridge the gap. Infection Contr Hosp Epidemiol 1994;15:335-8.

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