PURPOSE
To reduce transmission of multiple resistant organisms in the WFUP clinical settings.

POLICY  
Resistant organism precautions will be used to provide services to WFUP patients identified with a multiply resistant organism. This policy will be applied to patients with Multiply-resistant Staphylococcus aureus, Vancomycin-resistant Enterococcus and other organisms identified as being epidemiologically significant.

DESCRIPTION OF PROCESS OR TASK STEPS

           I.     Procedure:

A.     New Patients

Patients new to WFUP or WFUHS will be verified as having a resistant organism (RO). If the patient is referred by a physician, agency or healthcare facility not associated with WFUHS, the referring entity will be queried regarding whether the patient has resistant organisms.

B.     Infected or Colonized Patients:

1.      Patients suspicious of having a resistant organism will have their status verified.                       

a.      The WFUHS Infection Control Officer (ICO) will be contacted by WFUP clinic nurses. 

b.      The ICO will contact the referring physician or facility and verify MRO status.  Once verified, the information will be faxed to WFUMBC Infection Control.

c.      WFUBMC Infection Control Department will code patients in the system.

d.     Patients identified with a multiply resistant organism will be coded in the IDX system. 

2.      Patients not coded in IDX system

a.      The (ICO) will be contacted by WFUP clinic nurses. 

b.      The ICO will verify RO status in the WFUBMC Infection Control database.

c.      Patients within the database but not coded will be identified to WFUBMC Infection Control.

3.      Identified patients will have a fluorescent green sticker placed on the front and back of the chart.

C.     Visits of Infected or Colonized Patients

1.      WFUP staff will review on a daily basis the patient schedule to identify patients infected or colonized with a RO.

2.      A determination should be made as to the site of infection e.g., blood, wound, respiratory tract. 

3.      Once the patient has been arrived, the patient will be directed to the waiting area.  Nursing will be notified patient that the patient has arrived. The nursing assessment, update of patient clinical information and vital signs should be obtained in the exam room.

4.      A fluorescent green card “Resistant Organism Precautions” will be placed on the exam room door.

5.      If additional tests or evaluations for patients required, the WFUP clinics or WFUBMC services will be notified of the need for the use of resistant organism precautions.

PPE requirements

1.     Gloves will be worn for all patient contact and discarded upon leaving the room.

2.     Gowns will be worn for all patients identified with unhealed open sites and discarded upon leaving the room.

3.     A mask will be worn if patient has MRO’s in the sputum or respiratory tract discarded upon leaving the room.

Hand Hygiene

1.     Hand hygiene will be done by all WUFP faculty and staff who interact with the patient.

2.     Waterless alcohol hand gels or antimicrobial soaps are acceptable agents for hand hygiene.

Housekeeping

Patient exam table and other surfaces contaminated with drainage shall be cleaned between patients.  This cleaning can be done by clinic staff or Housekeeping whichever is most expedient.

Post-discharge Surveillance Cultures

1.     When the need to verify if a patient has cleared a RO, the ICO will consult the Hospital Epidemiologist and the patient’s physician.

2.     Arrangements will be made with WFUBMC Infection Control to obtain appropriate cultures.

3.     Repeat cultures will be obtained at the patient’s next visit.

4.     If a patient has remained culture negative for 3 visits, separated by 30 days each, the patient coding for ROP will be turned off.

5.     This coding will be done by WFUBMC Infection Control.