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.
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What does Oregon law require?
The new rule “Communication During Patient Transfer of Multidrug-Resistant Organisms” OAR 333-019-0052 (pdf)
sets patient safety expectations about timely communication between health care 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:
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 5 carbapenemase-producing Enterobacteriaceae have been reported in Oregon.
Why are we doing this?
MDROs like the ones listed above cause significant infection, injury, and even death. These organisms remain uncommon in Oregon health care facilities, so it is imperative 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 health care facilities do?
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 examples below), or add a field in their electronic medical record to populate their current transfer worksheets. OPHD's Healthcare-Associated Infection program and Oregon Patient Safety have resources and documents to assist with meeting this requirement.
Sample interfacility transfer forms