On this page: Background | Educational Resources | Setting-Specific Resources | Patient Resources | Data & Reporting | Laboratory Testing | Collaborations
Background
MDROs are germs that are difficult to treat. Many antibiotics don’t work well against them. Common types of MDROs are methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), extended-spectrum beta-lactamase-producing Enterobacterales (ESBL), carbapenem-resistant Enterobacterales (CRE), carbapenem-resistant Acinetobacter baumannii, and carbapenem-resistant Pseudomonas aeruginosa. To learn more about how these germs become resistant, visit the CDC Antibiotic Resistance website.
MDRO germs are usually spread by direct contact with infected people, especially through wounds or stool. They can cause infections if they enter the body, often through medical devices like ventilators, IVs, urinary catheters, or wounds from injuries or surgery. To prevent these infections, it’s important to follow safety rules, use the right cleaning products, and make sure staff follow infection control practices.
Public Health Response:
VDH works with healthcare facilities to target and slow the spread of certain dangerous MDROs (called targeted MDROs) like Candida auris and carbapenem-resistant organisms (CROs) that produce carbapenemase (called carbapenem-producing organisms or CPOs). VDH follows the CDC Guidance for a Public Health Response to Contain Novel or Targeted MDROs. Facilities should collaborate with their local health department on response efforts.
Educational Resources
Refer to the C. auris and Carbapenem-Resistant Organisms (CRO) web pages for educational resources specific to these germs. Other MDRO and infection prevention and control (IPC) resources can be found below.
- Antimicrobial Stewardship
- Hand Hygiene
- Cleaning, Disinfection, and Sterilization
- HAI/AR Special Edition Newsletter: MDRO Prevention and Containment
- Infection Control Precautions
- Infection Prevention and Control (IPC) - Access the IPC page for comprehensive guidance on infection prevention
- MDRO Prevention Recommendations
- Memo: Improving Environmental Cleaning to Prevent MDRO Transmission
- Fact Sheet: Methicillin-resistant Staphylococcus aureus (MRSA) Infection
- Personal Protective Equipment
- Fact Sheet: Vancomycin-intermediate Staphylococcus aureus (VISA) and Vancomycin-resistant Staphylococcus aureus (VRSA) Infection
- Fact Sheet: Vancomycin-resistant Enterococci (VRE) Infection
VDH Infection Prevention and Control Assessments: The HAI/AR team is available to conduct a no-cost, non-regulatory, onsite visit to help a facility identify its infection prevention strengths and areas of opportunity.
- Antimicrobial Resistance
- Antimicrobial Resistance and Patient Safety Portal
- ESBL-producing Enterobacterales
- Guidance for a Public Health Response to Contain Novel or Targeted MDROs
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Mid-Atlantic Webinar Series:
- Multidrug-resistant Organisms (MDRO) Management Guidelines
- Public Health Strategies to Prevent the Spread of Novel and Targeted MDROs
- Vancomycin-resistant Enterococci (VRE)
- Vancomycin-resistant Staphylococcus aureus
- Association of Public Health Laboratories: Colonization Screening for Multidrug-Resistant Organisms in Healthcare Facilities
- Virginia Healthcare-Associated Infections Advisory Group
- Virginia Infection Prevention and Control Training Alliance (VIPTA) - search the education and training resource library for resources related to MDROs.
- VCU Virginia Infection Prevention Training Center
- Virginia Infection Prevention Training Center (VIPTC) - courses and trainings related to MDROs
Setting-Specific Resources
Refer to the C. auris and Carbapenem-Resistant Organisms (CRO) web pages for setting-specific resources specific to these germs.
- CDC Interfacility Transfer Form - The patient transfer form helps make it easier to share information when patients are moved between different places for care. Hospitals and groups focused on making patient safety better can change and use this form to fit their needs.
Nursing Homes/Skilled Nursing Facilities
- VDH Enhanced Barrier Precautions Implementation Algorithm for Nursing Homes
- VDH Quick Guides for Nursing Home Infection Preventionists
- Quick Guide for Emergency Medical Services (EMS) Multidrug-resistant Organism (MDRO) Prevention (Pennsylvania Department of Health)
Patient Resources
Refer to the C. auris and Carbapenem-Resistant Organisms (CRO) web pages for patient resources specific to these germs.
Data & Reporting
Data dashboards are available for
Reporting Requirements
- Physicians and directors of medical facilities must report suspected or confirmed vancomycin-intermediate or vancomycin-resistant Staphylococcus aureus infection, Candida auris, and CPOs to the local health department within 3 days.
- Any suspected or confirmed MDRO outbreak should be reported immediately to your local health department.
- Directors of laboratories must report the following within 3 days, along with available antimicrobial susceptibility results: vancomycin-intermediate or vancomycin-resistant Staphylococcus aureus*, Candida auris*, carbapenemase-producing organisms, carbapenem-resistant Enterobacterales* and carbapenem-resistant Pseudomonas aeruginosa*.
- *Laboratories must submit the initial isolate (preferred) within five days or the clinical specimen within two days of a positive result to the Division of Consolidated Laboratory Services.
- A specimen or isolate must include patient and physician identities.
Collaborations
- Virginia Healthcare-Associated Infections Advisory Group (VHAG) Annual Priority Workgroup
Every year, VHAG decides on a specific HAI topic of concern that has statewide implications. Currently, the annual priority is “Communication as a strategy for combatting the spread of multidrug-resistant organisms (MDROs) in Virginia”.
The workgroup is addressing opportunities to improve communication with transfers of care regarding MDROs. This work includes:
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- Evaluating the legislative and regulatory framework that impacts the MDRO communication.
- Identifying tools and resources to help bridge the MDRO communication gap between healthcare facilities.
- Developing educational material for private labs regarding MDRO testing, identification, and communicating results.
- Emergency Department Care Coordination (EDCC) Program
The Emergency Department Care Coordination (EDCC) Program, started in 2017, connects healthcare facilities like hospitals and nursing homes across the state. EDCC now includes alerts for Candida auris and CPOs.
Since these alerts aren’t updated in real-time and only cover patients known to VDH, facilities should share MDRO status when transferring patients. VDH suggests using the CDC Inter-Facility Infection Control Transfer Form for complete MDRO information. Note: The MDRO flags are an extra tool, not a substitute for direct communication.