Frequently asked questions about HAIs
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What is an MDRO?
MDRO stands for multidrug-resistant organism. An MDRO causes human disease which has acquired antibiotic resistance, as listed and defined by the Centers for Disease Control and Prevention (CDC) in Antibiotic Resistance Threats in the United States, 2013 (pdf).
View a list of selected MDRO definitions (pdf).
MDROs include, but are not limited to:
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Vancomycin-resistant Enterococcus (VRE)
- Carbapenem-resistant Enterobacteriaceae (CRE)
- Multidrug-resistant Acinetobacter baumannii
- Multidrug-resistant Pseudomonas aeruginosa
- Other Gram-negative bacteria producing extended beta-lactamases (ESBL)
- Toxin-producing Clostridium difficile
Other bacteria of interest (but which are rare) include drug-resistant Streptococcal pneumoniae.
MDRO infections can increase complications, prolong hospitalizations, require treatment with expensive, difficult to tolerate antibiotics, and sometimes cause death.
For a snapshot of what is happening across the United States with MDRO surveillance and CDC definitions, review the Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention: Antimicrobial-Resistant Pathogens Associated with Healthcare-Associated Infections 2009-2010 (D.M Sievert, et. al).
What are Standard Precautions?
Standard Precautions means approaching every patient or resident care situation in a way that prevents acquiring or passing on an infection, regardless of suspected or confirmed infection status of the patient or resident. CDC's HAI website has excellent resources and training.
Standard Precautions include:
- Hand hygiene - first and foremost!
- Use of personal protective equipment (for example, gloves, gowns, facemasks), depending on the anticipated exposure
- Respiratory hygiene and cough etiquette
- Safe injection practices
- Safe handling of potentially contaminated equipment or surfaces in the patient environment
What are Transmission-based Precautions?
Transmission-based Precautions are the set of infection control practices that should be used when Standard Precautions are not alone sufficient to prevent transmission of a potential pathogen or organism of epidemiologic significance.
There are three generally recognized categories of precautions, which are added to Standard Precautions alone or in combination, depending on the likely mode of transmission of the suspected organism:
- Droplet Precautions, for organisms transmitted by large respiratory droplets (e.g. meningococcus, influenza)
- Contact Precautions, for organisms that may be transmitted directly or indirectly through contact with the patient or the patient’s environment (e.g., MRSA, VRE, CRE, norovirus)
- Airborne Precautions, to prevent transmission of organisms that are transmitted by small particle aerosols (such as tuberculosis, measles).
Get CDC resources about using Personal Protective Equipment for Transmission-based Precautions.
Appendix 1 from the Healthcare Infection Control Practices Advisory Committee’s Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007, provides one reference for recommended precautions; individual facilities may have adopted their own criteria.
Get CDC resources for infection prevention in different facility settings.
What does the rule on Multidrug-Resistant Organism Transfer Communication (OAR 333-019-0052) do?
The rule improves communication about multidrug-resistant organisms (MDRO) and Transmission-based Precautions between health care facilities. The expectation is that the referring facility communicates to the receiving facility about a patient’s infection or colonization with an MDRO or a pathogen that requires more than Standard Precautions to prevent transmission.
MDROs or pathogens requiring Transmission-based Precautions can be spread even without obvious infection (e.g., colonization) between health care facilities. When MDRO and Transmission-based Precautions status are communicated at each transfer, appropriate precautions can be promptly initiated, and fewer secondary patients are affected.
For more information, please read the Interfacility Transfer Communication FAQs (pdf).
Who does this rule apply to?
It applies to a “facility” defined as:
- A health care facility - hospital, long-term care facility, freestanding birthing center, ambulatory surgery center, outpatient dialysis center;
- An infirmary (for example, in a jail or prison);
- A residential facility or assisted living facility as those terms are defined in ORS 443.400;
- An adult foster home as that term is defined in ORS 443.705;
- A hospice program as that term is defined in ORS 443.850; and
- Any other facility that provides 24-hour patient care.
How do I contact my local health department?
Get local health department contact information.
Who do I contact if I have a question about the rule?
Contact Oregon Public Health Division's HAI Program.
Resources on health care facility infection prevention and control can be found at Oregon Patient Safety Commission, Centers for Disease Control and Prevention (CDC) and Oregon's HAI website.