Communication during Patient Transfer of Multidrug-Resistant Organisms (MDRO)
As part of best practice during patient transfers, information about a patient’s medical status, including colonization or infection with a multidrug-resistant organism, should travel with a patient and be readily available to medical providers.
What’s the new rule about?
The new rule “Communication during Patient Transfer of Multidrug-Resistant Organisms” OAR 333-019-0052 (scroll to -0052)
sets patient safety expectations about timely communication between healthcare facilities about multidrug-resistant organisms or pathogens that warrant Transmission-based Precautions. Transmission-based precautions are disease- or syndrome-specific precautions taken in addition to Standard Precautions, based on the disease or syndrome transmission route and exposure risk (e.g., influenza requires droplet; tuberculosis requires airborne; diarrhea requires contact).
Effective January 1, 2014, when a referring health care facility transfers or discharges a patient who is infected or colonized with a multidrug-resistant organism (MDRO) or pathogen which warrants Transmission-based Precautions, it must include written notification of the infection or colonization to the receiving facility in transfer documents. The referring facility must ensure that the documentation is readily accessible to all parties involved in patient transfer (for example, referring facility, medical transport, emergency department, receiving facility).
In Oregon, health care facilities include hospitals, ambulatory surgery centers, nursing homes, residential care facilities, assisted living facilities, and adult foster homes.
MDROs include, but are not limited to:
Methicillin-resistant Staphylococcus aureus (MRSA);
Vancomycin-resistant Enterococcus (VRE);
Carbapenem-resistant Enterobacteriaceae (CRE);
Multi-drug resistant Acinetobacter baumannii;
Toxin-producing Clostridium difficile.
In special (and rare) situations, if a facility transfers or discharges a patient with laboratory-confirmed, carbapenemase-producing Enterobacteriaceae, the facility must notify the local health department communicable disease staff within 1 working day of the date and destination of the transfer or discharge. Since 2010, only 4 carbapenemase-producing Enterobacteriaceae have been reported in Oregon.
Why are we doing this?
MDROs like methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Enterobacteriaceae (CRE), Acinetobacter baumannii, Pseudomonas aeruginosa, and Clostridium difficile cause significant infection, injury, and even death. These organisms are relatively rare in Oregon health care facilities compared to places like New York, Detroit, Chicago, Los Angeles, and abroad. It is in the best interest of the public’s health to keep these organisms uncommon in Oregon health care faculties, and, when they do occur, to optimize communication to prevent their spread.
Other syndromes like influenza-like illness and acute gastroenteritis or diarrhea also trigger Transmission-based Precautions in health care facilities in order to prevent spread and protect our most vulnerable populations. Thus, it is important that health care facilities share MDRO and other contagious disease information when transferring a patient from one facility’s care to another.
What should we do about this?
Precautions taken when a patient with an MDRO or transmissible pathogen enters a health care facility will best prevent spread. Depending on the bug, precautions to prevent transmission (e.g., Transmission-based Precautions) include hand washing and wearing gowns and gloves.
Oregon Public Health Division (OPHD) recommends that staff responsible for facility infection control work with clinical and administrative staff who oversee the admission and discharge process to identify how this information will be added to current transfer procedures. Some facilities may want to use a pre-made form (see links below), or add a field in their electronic medical record to populate their current transfer worksheets. OPHD Healthcare Associated Infections program and Oregon Patient Safety have resources and documents to assist with meeting this requirement.