Preventing the emergence and spread of multidrug-resistant organisms requires a combination of comprehensive infection prevention practices and effective antimicrobial stewardship efforts. We’ve prepared a checklist for hospitals to use as a starting point:1
□ Have all clinical and patient care personnel been trained and assessed on effective hand hygiene before and after every contact with a patient or their environment?
□ Are alcohol-based sanitizers and soap and water kept well supplied and conveniently located for routine care?
□ Are healthcare workers regularly evaluated to ensure adherence to hand hygiene procedures?
□ Are there consequences for non-adherence?
Device-associated infection reduction2
□ Has the hospital implemented standardized bundles and decision-support checklists to reduce device-associated infections?
□ Does the electronic medical record or other system prompt clinicians to place urinary catheters only when necessary and remove them as soon as feasible to prevent catheter-associated urinary tract infections?
□ Do patients with central lines receive daily chlorhexidine baths?
□ Are IV tubing and high-touch areas wiped down daily for patients with central lines?
□ Do ventilator-assisted patients receive daily oral care?
□ Are high touch surfaces on the ventilators cleaned daily?
Limiting antibiotic exposure
□ Does the hospital offer clear, accessible decision support to determine likely diagnosis?
□ Are order sets available to define appropriate agent, dosage and duration of antibiotic therapy?
□ Must the clinician document the indication for antibiotics when an order is written?
□ Is the indication highlighted on the medication administration record?
□ Are start date, day of treatment, and expected duration documented in patient record?
□ Has the hospital automated antibiotic “time outs” after 48-72 hours of treatment if laboratory results do not support the indication?
□ Are patients automatically switched from IV to oral antibiotics as soon as feasible?
□ Do clinicians request appropriate cultures prior to initiating antibiotics?
□ Has the hospital implemented a pharmacy-driven prospective audit with feedback to prescribers for antibiotic use, including alerts for potentially duplicative medications, dosage adjustments for organ dysfunction, inappropriate agent/dosage/duration for indication, and dose optimization for treatment of pathogens with reduced susceptibility?3
□ Are rates of acceptance for suggested interventions tracked and reported by prescriber?
Admission and transfer precautions
□ Do referring facilities provide notification of prior infection and institutional antibiotic-resistance problems when transferring patients?
□ Are transferred patients isolated when they come from communities or facilities with known MDRO outbreaks or endemic issues?
□ Has the hospital instituted the most current, rigorous standards for cleaning and disinfection of the environment, including reusable equipment such as ventilators and endoscopes?
□ Does microbiology have access to customized screening media for organisms of concern?
What policies and procedures have been implemented at your hospital to combat the emergence and spread of MDROs?
Sandora TJ, Goldmann DA. Preventing Lethal Hospital Outbreaks of Antibiotic-Resistant Bacteria. New England Journal of Medicine. December 6, 2012; 367:2168-2170. DOI: 10.1056/NEJMp1212370
Lillis K. Device-Associated Infections: Evidence-based Practice Remains the Best Way to Decrease HAIs. Infection Control Today. April 11, 2015.
Checklist for Core Elements of Hospital Antibiotic Stewardship Programs. CDC.