1. Pre-emptive isolation.

Alert code of previously known multidrug-resistant organisms (MDRO) positive patients and pre-emptive contact precautions (CP) could help in reducing the spread of MDRO.

  • MRSA: in the SHEA guidelines on strategies to prevent MRSA transmission in acute care hospitals is recommended to implement an alert system that identifies readmitted or transferred MRSA-colonized or MRSA-infected patients to promptly initiate appropriate control measures and minimize opportunities for transmission [1].

  • MDR-Gram-negative bacteria: authors of the ESMID guidelines recommend to use alert code to identify promptly patients already known as colonized or infected with MDR-A. baumannii, MDR-Klebsiella pneumonia and ESBL-Enterobacteriaceae (with the exception of ESBL-E. coli) at hospital/ward admission and use pre-emptive CP in acute setting where these bacteria are endemic. Moreover pre-emptive CP are recommended for patients admitted from ICU or other wards with cases of these MDRO already detected. No evidence is available to provide recommendation as for, or against the use of alert-code and pre-emptive isolation for patients colonized or infected with Burkholderia cepacia and Stenotrophomonas maltophilia [2].

In epidemics settings alert code and pre-emptive isolation are recommended for patients already known as colonized with ESBL-producing Enterobacteriaceae, MDR-K.pneumoniae and MDR-P. aeruginosa at hospital/ward admission [2].

References.
  1. Calfee DP, Salgado CD, Milstone AM, Harris AD, Kuhar DT, Moody J, et al. Society for Healthcare Epidemiology of America. Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014 Jul;35(7):772-96
  2. Tacconelli E, Cataldo MA, Dancer SJ, De Angelis G, Falcone M, Frank U, et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect. 2014 Jan;20 Suppl 1:1-55.

 Original contribution from:

Maria Adriana Cataldo and Nicola Petrosillo, National Institute for Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy.