Infection control protocols in healthcare environments are designed to interrupt the spread of pathogens, protecting both patients and staff. These protocols begin with baseline measures applied to every patient and escalate to specialized steps for organisms that pose a higher risk. Transmission-Based Precautions (TBP) are specialized protocols implemented in addition to routine care to contain specific infectious agents. These enhanced measures are necessary when dealing with pathogens that are difficult to treat, such as Multi-Drug Resistant Organisms (MDROs).
Understanding Multi-Drug Resistant Organisms (MDROs)
Multi-Drug Resistant Organisms (MDROs) are microorganisms, primarily bacteria, that have developed resistance to one or more classes of antimicrobial agents. This acquired resistance means common antibiotics are no longer effective, making infections caused by these organisms significantly harder to manage due to limited treatment options.
The group of MDROs is diverse, and the specific resistance profile determines the level of concern for healthcare systems. Well-known examples include Methicillin-resistant Staphylococcus aureus (MRSA), which resists certain beta-lactam antibiotics, and Vancomycin-resistant Enterococcus (VRE). Carbapenem-resistant Enterobacteriaceae (CRE) is another important category, as carbapenems are often considered last-resort antibiotics for severe infections.
The Foundation of Infection Control: Standard Precautions
All patient care activities are built upon the foundation of Standard Precautions, regardless of a patient’s known infection status. These are the minimum infection prevention practices that apply to blood, all body fluids, non-intact skin, and mucous membranes. The primary strategy for preventing transmission is the consistent application of these practices to every patient interaction.
Hand hygiene is the most effective component of Standard Precautions, requiring the use of soap and water or an alcohol-based hand rub before and after patient contact. The protocol also includes the use of Personal Protective Equipment (PPE), such as gloves, gowns, or masks, when exposure to bodily fluids is anticipated. Standard Precautions also mandate safe injection practices, proper handling of contaminated patient-care equipment, and adherence to respiratory hygiene.
Contact Precautions: The Primary Defense Against MDRO Spread
For patients known to be colonized or infected with an MDRO, the primary Transmission-Based Precaution required is Contact Precautions. This protocol is necessary because MDROs are most commonly transmitted through direct contact with the patient or indirect contact with contaminated environmental surfaces and medical equipment. The goal is to create a physical barrier and a controlled environment to prevent the transfer of the organism to other patients.
Contact Precautions begin with dedicated patient placement, typically involving a private room or cohorting patients with the same MDRO. A mandatory requirement is donning a gown and gloves before entering the room. This barrier protection must be carefully removed and discarded inside the patient’s room, followed by hand hygiene, to prevent contamination of common areas.
To further limit environmental spread, noncritical medical items must be dedicated for use only on that specific patient, such as stethoscopes and blood pressure cuffs. Frequent and thorough cleaning of the patient environment is also intensified, focusing on high-touch surfaces like bedrails, doorknobs, and bathroom fixtures. Patient movement outside the room is strictly limited to medically necessary procedures, and the infected or colonized areas must be covered or contained during transport.
When Other Transmission Precautions Apply
While Contact Precautions are the default for MDROs, other Transmission-Based Precautions may be added depending on the clinical presentation of the patient’s infection. The site of the infection determines the additional measures, not the resistance status of the organism. This means that Droplet or Airborne Precautions may be co-applied if the MDRO is causing a respiratory disease.
If an MDRO is found in a patient with symptoms suggesting transmission via respiratory droplets, Droplet Precautions are implemented alongside Contact Precautions. This requires healthcare personnel to wear a mask upon entering the patient’s space to protect against infectious droplets generated by coughing or talking.
Airborne Precautions
For MDROs associated with agents that can remain suspended in the air over long distances, Airborne Precautions are required. This stringent protocol mandates placing the patient in a specialized Airborne Infection Isolation Room (AIIR) with negative air pressure. Staff must also wear a fit-tested N95 respirator mask when entering the room.