Patient centred care versus multi-resistant organism (MRO) centred care: A new way to look at MRO management in acute care settings

Joanna Harris 1, Beth Bint 1, Julie Rieck 1, Megan Brown 1

Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia


Modern healthcare is characterised by the mantra of patient-centred care, however the management of multi-resistant organisms (MRO) risks becoming MRO-centred care. The controls implemented can lead to inequitable access to healthcare and may compromise the clinical and psychological well-being of patients. This presentation describes the impact of implementing a risk-managed Standard Precautions focussed model for the management of patients colonised with MROs endemic to a 500 bed hospital in NSW.

An intensive programme to strengthen the application of Standard Precautions was implemented. This model constituted achievement of >70% hand hygiene compliance, cleaning and disinfection of all toilets, aprons used for direct contact with all patients, glove use restricted to blood and body substance contact, and point of use access to detergent wipes for non-critical reusable equipment cleaning.
Once established, MRO-based assessment of the need for Contact Precautions were replaced with a patient-focussed risk assessment. This incorporated consideration of the clinical setting to inform decision-making regarding patient accommodation and precautions to be implemented.
Ongoing surveillance of MRO acquisitions was used to evaluate the impact of this change in practice.

Surveillance of nosocomial acquisitions for MROs identified that overall rates of MRSA, VRE and multi-resistant gram negative organisms (MRGNs) reduced from 13.5 per 10,000 OBD in January 2014 to 7.5 per 10,000 OBD in March 2016.
MRSA, VRE (both vanA and vanB) and MRGN acquisitions all individually showed a downward trend.

MRO transmission can be controlled through the implementation of modified Standard Precautions and a risk assessment approach.

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