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Guidelines for Prevention and Control of Infection Due to Antibiotic Resistant

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Guidelines for Prevention and Control of Infection Due to Antibiotic Resistant Guidelines for Prevention and Control of Infection Due to Antibiotic Resistant Organisms Updated December 2020 Florida Department of Health Division of Disease Control & Health Protection Bureau of Epidemiology 850-245-4401 (24/7) FLHealth.gov Table of Contents I. Statement of Purpose ................................................................................................... 1 II. Definitions ................................................................................................................... 2 III. Introduction ................................................................................................................ 8 IV. Background ................................................................................................................ 9 A. Methicillin•Resistant Staphylococcus aureus (MRSA) .......................................... 9 B. Vancomycin•Resistant Enterococci (VRE) ......................................................... 10 C. Clostridioides difficile .......................................................................................... 10 D. Multidrug•Resistant Gram•Negative Bacilli (MDR•GNB) .................................... 11 1. Acinetobacter baumannii ........................................................................... 11 2. Carbapenem•Resistant Enterobacteriaceae (CRE) ................................... 12 E. Candida auris (C. auris) ..................................................................................... 13 V. Colonization vs. Infection .......................................................................................... 13 A. Colonization ....................................................................................................... 13 1. C. difficile ................................................................................................... 13 2. Enterococci ................................................................................................ 13 3. Methicillin•Resistant Staphylococcus aureus (MRSA) ............................... 14 4. Multidrug•Resistant Gram•Negative Bacilli (MDR•GNB)............................ 14 5. Candida auris (C. auris)............................................................................. 14 B. Infection ............................................................................................................. 14 VI. Epidemiology ........................................................................................................... 15 A. Health Care•Associated MethiciIIin-Resistant Staphylococcus aureus (HA•MRSA) ............................................................................................................. 15 B. Community•Associated Methicillin•Resistant Staphylococcus aureus (CA•MRSA) ............................................................................................................. 15 C. Vancomycin•Resistant Enterococci .................................................................... 16 D. Clostridioides difficile .......................................................................................... 17 E. Multidrug•Resistant Gram-Negative Bacilli (MDR•GNB) .................................... 18 F. Carbapenem-Resistant Enterobacteriaceae ....................................................... 18 G. Candida auris (C. auris) ..................................................................................... 19 VII. Control Measures .................................................................................................... 20 A. General Control Measures ................................................................................. 20 1. Infection Control Plan ................................................................................ 20 2. Hand Hygiene ............................................................................................ 20 3. Communications to Maintain Appropriate Patient-Based Infection Control Precautions Between and Within Facilities .................................................... 21 4. Standard Precautions ................................................................................ 22 5. Contact Precautions .................................................................................. 22 6. Enhanced Barrier Precautions ................................................................... 22 7. Education .................................................................................................. 23 8. Visitors....................................................................................................... 23 9. Surveillance ............................................................................................... 23 10. Environmental Measures ......................................................................... 24 11. Administrative Support ............................................................................ 25 12. Antimicrobial Stewardship ....................................................................... 25 VIII. Decolonization Therapy ......................................................................................... 26 IX. Prevention ................................................................................................................ 28 A. Institution Specific Control Measures ................................................................. 28 1. Acute Care Facilities ................................................................................. 28 2. Long-Term Care Facilities ......................................................................... 29 3. Home Health Care/Hospice ....................................................................... 35 4. Doctors’ Offices/Outpatient Clinics ............................................................ 35 5. Dialysis Settings ........................................................................................ 35 6. Schools for the Physically and Mentally Challenged ................................. 36 7. Assisted Living Facilities/Rest Homes/Retirement Centers ....................... 36 8. Rehabilitation Facilities .............................................................................. 37 9. Psychiatric Hospitals ................................................................................. 37 10. Correctional Facilities .............................................................................. 37 11. Patients Discharged to Their Homes ....................................................... 37 12. Emergency Medical Services (EMS) and Non•Emergent Transport ........ 38 X. Outbreak Control ....................................................................................................... 39 XI. The Infected or Colonized Health Care Worker ....................................................... 41 XII. Antibiotic Resistance in Animals ............................................................................. 41 XIII. Control of MRSA in Community Settings ............................................................... 42 A. Personal Hygiene ............................................................................................... 43 B. Control Measures for Health Care Practitioners ................................................. 43 C. Households ........................................................................................................ 44 D. Schools .............................................................................................................. 44 E. Day Care Settings .............................................................................................. 45 F. Athletic Settings .................................................................................................. 46 G. Workplace .......................................................................................................... 46 H. Correctional Facilities ......................................................................................... 47 XIV. Vancomycin Non•Susceptible Staphylococcus—An Emerging Pathogen ............. 47 XV. References ............................................................................................................. 49 XVI. Resources ............................................................................................................. 56 XVII. Reportable Diseases in Florida ............................................................................. 59 Appendix A .................................................................................................................... 60 III.A. Standard Precautions ..................................................................................... 60 III.A.1. New Elements of Standard Precautions ...................................................... 61 III.A.1.a. Respiratory Hygiene/Cough Etiquette ...................................................... 61 IV. Standard Precautions ........................................................................................ 62 IV.A. Hand Hygiene ................................................................................................ 63 IV.B. Personal Protective Equipment (PPE) ........................................................... 63 IV.C. Respiratory Hygiene/Cough Etiquette ............................................................ 65 IV.D. Patient Placement .......................................................................................... 65 IV.E. Patient Care Equipment and Instruments/Devices
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