Policy Manual sample

MDT Home Health Care Agency, Inc. GUIDELINES ON CARING FOR PATIENTS WITH MULTI-DRUG RESISTANT ORGANISMS Antimicrobial resistance is fast becoming a global concern with rapid increases in multidrug- resistant bacteria. Some pathogens are becoming untreatable. A patient with clinical multidrug-resistant organism infection may be admitted if the following standards are met: • A Patient’s physician has evaluated and determined the patient has colonization with the multidrug-resistant organism. • If infection is identified, it should be treated appropriately. Presence of infection does not preclude admission. • Resolve diarrhea in patients prior to discharge from the Agency, if multidrug resistant organisms are in the stool. Our Staff follow Agency guidelines which should include, at a minimum, the following: • Standard precautions shall be practiced by all entering the patient’s room. • Use appropriate signage denoting the type of isolation precautions. • Handwashing will be done before and after any skin-to-skin contact which is more than incidental with a patient. Turning a patient requires handwashing afterward; simply touching dry skin does not. Handwashing is also to be done between care for different anatomical sites on the same patient, before eating or drinking, after toileting, and before and after glove use. Use of an antimicrobial or disinfecting agent with activity against gram-positive organisms is favored (e.g., chlorhexidine gluconate). • Gloves will be worn for any contact with a wound, open lesion, invasive site, or mucous membrane of a patient. Gloves must be changed between procedures. • Fomite transmission is generally not involved in transmission of MRSA. Patient waste will be disposed of in the ordinary manner which is appropriate for all solid waste. Fomite transmission is involved in transmission of VRE--an organism capable of living for seven days on a dry surface. • Gowns may be used for any contact with the patient. • Daily, routine cleaning must be encouraged in all patient areas to reduce the bacterial load. Cleaning must be done with an Environmental Protection Agency/Food and Drug Administration- approved disinfectant and cleaning performed in a sanitary manner consistent with facility procedures. Meticulous cleaning must be done when the patient with VRE is discharged. • Adhere to standard infection control principles, especially aseptic technique, decontamination and disinfection. • Remove gloves before leaving the room. • Wash hands with an antiseptic agent (e.g.,chlorhexidine gluconate). • Dedicate equipment for patients with multidrug-resistant organism(s). • Use only a disposable thermometer and leave it in the room. If the patient has a medical condition, particularly one involving immunosuppression (i.e. diabetes mellitus, renal failure or is on high-dose steroids or chemotherapy), which would place him/her at unusual risk for morbidity or mortality should the colonization progress to infection. This does not imply decolonization is an automatic standard. If decolonization is considered, the ability of the patient to tolerate the recommended medications must be weighed. The benefits of any medical therapy must be weighed against the risks. Decolonization and treatment is of limited value without concomitant staff education. Successful decolonization or treatment may be of limited use if patient care practices do not limit the ability to recontaminate or recolonize. Adherence to infection control standards is vital. Caregivers/Families with healthy immune systems who practice good hygiene are not at increased risk of becoming colonized or infected with a multidrug-resistant organism. Home Health Agency Nursing Care & Procedures K-183