Hi, welcome to module two, multidrug-resistant organisms or MDROs. Our ability to treat common bacterial infections goes back more than 70 years to the development of prontosil sulfa drug in the 1930s. In that short time frame, increasing resistance to these wonder drugs because of overuse and misuse has led to the rise of superbugs or multidrug-resistant organisms that are not treatable by any antibiotic. Antibiotic resistance has the potential to recreate a world where people routinely die from simple bacterial infections. This module will describe multidrug-resistant organisms, how they affect the residents in your facility and what you can do to help control their spread. There are four learning objectives for this module. You should be able to define multidrug-resistant organisms, identify several types of multidrug-resistant organisms, define the terms colonization and infection. And name at least two risk factors for getting infected with a multidrug-resistant organism. Before we get started, it is important that we define a few key terms that will be important throughout this module. Please click on a word or picture to learn more about each of these terms. Antibiotics are drugs that fight infections caused by bacteria. Antibiotics work by killing the bacteria or stopping their growth. Bacteria are microorganisms too small to see with the naked eye that exist in virtually all environments in the world, including on and inside the bodies of every living animal on earth. Most bacteria are not harmful, but some bacteria can cause infections like strep throat. Antibiotic resistance is the ability of bacteria to survive exposure to one or more antibiotics. Antibiotic resistance occurs when bacteria change in some way that reduces or eliminates the ability of the drug to fight the infection. Antibiotic resistant infections kill more Americans than HIV/AIDS and the number of lives claimed continues to rise. More than 2 million people acquire antibiotic resistant infections in the US each year and more than 100,000 die as a result. In nursing homes, the number affected is no less shocking. On average, there are 3.2 million residents currently in nursing homes. Of these, 250,000 acquire infections during their stay. Around 10% or 27,000 of these infections are caused by multidrug-resistant organisms. There are many multidrug-resistant organisms that can colonize or infect nursing home residents, but there are three that are most common. Methicillin-resistant Staphylococcus aureus or MRSA, Vancomycin-resistant Enterococci or VRE and extended spectrum beta-lactamase producing E. coli or ESBL E. coli. Staphylococcus aureus or staph is a very common germ that about one out of every three people has on their skin or in their nose, but only 2% of those carry MRSA. This germ does not cause any problems for most people who have it on their skin. But sometimes, it can cause serious infections such as skin or wound infections, pneumonia or infections in the blood. Antibiotics are prescribed to kill staph germs when they cause infections. Methicillin-resistant Staphylococcus aureus or MRSA is a type of staph that is resistant to some of the antibiotics that are often used to treat staph infections, making it difficult to treat. Vancomycin-resistant enterococci VRE, are a type of bacteria called enterococci that have developed resistance to many antibiotics, especially vancomycin. Enterococcal bacteria live in our intestines and female genital tract usually without causing problems. Enterococcal bacteria become a problem when they cause infection. These infections can occur anywhere in the body. Some common sites include the urinary tract, intestines, bloodstream and wounds. For some people especially those who are weak or ill, these infections can become serious. E. coli are very common bacteria that normally live harmlessly in the gut and are one of the most common bacteria causing infections in humans, particularly urinary tract infections, UTIs. These infections can sometimes progress to cause more serious infections such as kidney infections or spread to the blood, which can be life threatening. ESBL-producing strains are bacteria that produce an enzyme called extended spectrum beta lactamase which makes them more resistant to many commonly used antibiotics. And makes the infections harder to treat. In many instances, only a very limited group of antibiotics remain effective against ESBL producing E. Coli. Bacteria that are resistant to the effects of certain antibiotics are more difficult to treat. The bad news is that bacteria are becoming more resistant, not less. So a microbe that is resistant to many drugs becomes difficult or even impossible to treat. Because multidrug-resistant organisms are more difficult to treat, residents that become infected by one or more multidrug-resistant organisms often do worse and are sicker for longer periods of time. This is due in part to delays in detection and correct treatment, and the presence of multiple medical conditions that are made worse by the infection. Because nursing home residents live in close proximity to other persons and interact often, multidrug-resistant organisms can spread quickly among residents. The quick spread may also be attributable to frequent contact with potentially contaminated surfaces and persons. Nursing home residents are frequently colonized with one or more multidrug-resistant organisms. A majority of these are already colonized or infected when they are admitted. This is a concern because the more residents colonized or infected with multidrug-resistant organisms, the more likely it is that transmission between residents will occur. Colonization is defined as the presence of multidrug-resistant organisms on the resident's body that are in contact with the outside environment like the skin and nose. Colonization does not cause signs and symptoms of infection such as redness, pus, or fever. Infection is the invasion of multidrug-resistant organisms into the normally sterile tissue with clinical signs and symptoms of infection present such as fever, redness or pus. With infection, multidrug-resistant organisms produce toxins and other products that make the residents sick. Multidrug-resistant organisms are a serious concern for nursing homes. Studies have demonstrated that many residents are colonized with these multidrug-resistant organisms when they are admitted to nursing homes. It was estimated that 25% of residents in these studies were colonized with MRSA and 25 to 67% were colonized with VRE. This is a large reservoir of multidrug-resistant organisms that could lead to transmission to other residents. Once residents are colonized, they will continue to carry those same multidrug-resistant organisms for long periods of time. Estimates place the carriage duration for MRSA between 3 months and 3 years and 3 to 4 months for VRE. Similar to MRSA ,ESBL E. Coli has a carriage duration of 3 months to 4 years. Again, this long period of carriage increases the risk of transmission. Many residents may be colonized with more than one type of multidrug-resistant organism. This suggests that nursing homes can become reservoirs for multiple strains of multidrug-resistant organisms when colonized residents are accepted in transfer from many different outside facilities. Like other nursing homes or hospitals. Given there is a high rate of colonization in nursing homes, how is it that some residents become colonized while others do not? When colonized residents are compared to noncolonized residents, a variety of factors have been associated with an increased risk of colonization with multidrug-resistant organisms. These include an underlying illness, presence of an invasive device like a feeding tube, an IV or urinary catheter, prior antibiotic use, the presence of wounds, a decline in functional status. And an increased intensity of nursing care. Residents get multidrug-resistant organisms from multiple sources. The main way these multidrug-resistant organisms are spread is by the hands of health care personnel. The hands of healthcare personnel can spread multidrug-resistant organisms by touching one infected resident and then touching another resident without washing their hands. It can also occur by indirect contact when a health care provider touches a contaminated surface or piece of equipment and then touches a resident without washing their hands. Similarly, residents can spread multidrug-resistant organisms in the same way to each other if they fail to wash their hands after they become contaminated. When a resident is found to be colonized or infected with a multidrug-resistant organism, a delicate balance is required to preserve the resident's quality of life. Keeping in mind that the resident needs to socialize and move about freely in the facility. This needs to be done in a manner that protects other residents from getting a multidrug-resistant organism. This can be achieved by ensuring there are effective infection control policies and procedures in place. After viewing this module, you now know that multidrug-resistant organisms are common in nursing homes, causing frequent colonization and 10% of all infections in nursing homes. You also know that by practicing good hand hygiene and standard precautions, you protect the residents, yourself and the nursing home environment from the spread of multidrug-resistant organisms. If you have any questions related to infection control, you should contact your facility's infection preventionist for guidance and assistance. Thank you for viewing this module and good luck with your infection prevention efforts.
