Antibiotic resistance is a threat to everyone. Healthcare facilities should establish and follow policies for prevention and management of MDROs (MDRO risk assessment). The Washington State Department of Health supports and guides prevention and response efforts for certain uncommon MDROs to protect patients and prevent spread.
This toolkit provides organism-specific guidance and educational resources for Washington healthcare providers, healthcare facilities, and local health jurisdictions (LHJs) to prevent, detect, and contain targeted MDROs.
Targeted MDROs in Washington
The toolkit provides guidance for investigation and control activities for the following targeted organisms:
Candida auris (C. auris) is a fungus that can cause serious infections. It is often multidrug-resistant, can spread in hospitals and nursing homes, and is associated with a high mortality rate. C. auris is difficult to identify with standard laboratory methods which delays detection and measures to prevent spread.
Carbapenemase-producing Organisms (CPO) e.g., KPC, NDM, VIM, IMP, OXA-48, OXA-23, OXA-24/40, OXA-58 or OXA-235)
Carbapenemase producing organisms (CPO) including Enterobacterales such as Escherichia, Klebsiella, and Enterobacter; Pseudomonas aeruginosa; and Acinetobacter baumannii. CPO can cause serious infections. These bacteria can spread outside the gut and can be very difficult to treat.
Vancomycin-resistant Staphylococcus aureus (VRSA)
Vancomycin-intermediate Staphylococcus aureus and Vancomycin-resistant Staphylococcus aureus (VRSA) are types of antibiotic-resistant bacteria. Staphylococcus aureus is a bacterium that can cause infections that may be fatal.
Pan-resistant Organisms: defined as an organism is not susceptible to any of the antimicrobial drugs tested.
Targeted MDRO Resources
- What to Do if You Identify a Targeted Multidrug Resistant Organism in Your Facility (DOH)
- Interim Guidance for a Public Health Response to Contain Novel or Targeted Multidrug-resistant Organisms (MDROs): Updated December 2022 (CDC guidance)
- Public Health Strategies to Prevent the Spread of Novel and Targeted Multidrug-resistant Organisms (MDROs) (cdc.gov)
- Implementation of Personal Protective Equipment in Nursing Homes to Prevent Spread of Novel or Targeted Multidrug-resistant Organisms (MDROs)
Public Health Response & Guidelines
- Candida auris Reporting and Investigation Guideline (DOH)
- Carbapenem-Resistant Organisms Reporting and Investigation Guideline (DOH)
- Washington Disease Reporting System (WDRS) | Washington State Department of Health
*Required for CPO and C. auris cases. WDRS case report under “Highly antibiotic resistant organism” (HARO) and complete the HARO wizard question package including the “Clinical and Laboratory” tab.
Healthcare Facility Education and Infection Prevention
- Inter-Facility Infection Control Transfer Form (CDC)
- Environmental Checklist for Daily/Terminal Cleaning- Acute Care
- Selected EPA-Registered Disinfectants List
- Transmission Based Precautions and Required Signage Information and background (CDC)
- Isolation Precautions Signage (WA State Hospital Association)
- Notification Letter Template for Multidrug Resistant Organism Cluster
- Prepare Now to Prevent Transmission of Candida auris in your Healthcare Facility
- Candida auris: Working together to prevent spread in our healthcare facility (PowerPoint)
- Candida auris: Working Together to Prevent Spread - YouTube
Patient/Family Education & Notification
- CRE Patient Notification Template
- Moving to a Hospital or Skilled Nursing Facility - What to Expect when You Have CRE
- Trasladarse a Un Hospital o Centre de Enfermeria Especializada - Que Esperar Cuande Tiene CRE
- Acinetobacter (CRAB) Fact Sheet
- Carbapenem Resistant Enterobacterales (CRE) Fact Sheet
- Candida Auris Fact Sheet
- Candida auris Fact Sheet for Patients and Families (Spanish)(CDC)
- Candida auris Colonization Fact Sheet for Patients (English)(CDC)
- Candida auris Testing Fact Sheet for Patients (CDC)
- Candida auris Testing Fact Sheet for Patients (Spanish)(CDC)
- Candida auris: A Drug-resistant Germ that Spreads in Healthcare Facilities
- (CDC)Pseudomonas (CRPA) Fact Sheet
Screening and Laboratory Testing
Links and documents related to isolate submission, testing and response screening.
- Antibiotic Resistance | A.R. & Patient Safety Portal (cdc.gov)
- ARLN-Washington Antimicrobial Resistance Laboratory Network Lab Test Menu
- Candid aauris
- Candida auris screening-verbal consent example
- Candida auris Fact Sheet for Laboratory Staff (CDC)
- Carbapenem-resistant Enterobacteriaceae (CRE) and other Carbapenem-Resistant Organisms
- CRE reports, Historic
- Expanded Antimicrobial Susceptibility Testing (ExAST) for Hard-to-Treat Infections Fact Sheet (CDC)
- FAQ and Sample Scripts for MDRO Screening (Word)
- MDRO Dashboard