Infection Control for New York Health Care Professional ‒ 2024 Update ________________________________
• Healthcare personnel screening in the absence of known or suspected transmission from HCP or other strong epidemiologic links is not recom- mended. • Household contact screening of contacts who have extensive contact to determine if transmission-based precautions are necessary. • Contact screening to evaluate residential care set- tings to determine if screening is appropriate. Priori- tize roommates and residents who share a bathroom with the index patient and residents with frequent inpatient exposure. If transmission is identified, con- sider broader screening to inform infection control measures in the facility. • Consider screening staff if practices result in signifi- cant exposure to the staff member assisting residents with MDROs with toileting and bathing without use of personal protective equipment or hand hygiene. Include staff members with frequent hospital admis- sions, or if there is known or suspected transmission to or from a staff member. 4. Clinical laboratory prospective and retrospective sur- veillance to review laboratory testing results, typically from clinical cultures, from healthcare facilities where the index patient recently received care to assess for additional cases. 5. Environmental cultures. Most public health responses to Tier 2 organisms and mechanisms will not require environmental cultures. In some situations, envi- ronmental cultures may help identify environmental reservoirs or evaluate the effectiveness of cleaning and disinfection. 6. Implement a system to ensure adherence to infection control measures. Healthcare facilities should: • Educate and inform the HCP and visitors for the patient about organism and precautions indicated to prevent transmission. • Ensure that supplies are available to implement Transmission-Based or Enhanced Barrier Precau- tions. • Conduct ongoing adherence monitoring of infec- tion control practices and provide feedback to HCP. Tier 3: Organisms in this group include MDROs targeted by the facility or region for epidemiologic importance that have been identified frequently across a region, indicating advanced spread, but are not considered endemic. These organisms might be more common in other areas of the United States. Information is available about how transmission of these organisms occurs and the groups primarily at risk. Examples include KPC-CRE, Acinetobacter baumannii , and C. auris in certain regions of the United States where these organisms are more regularly identified but are not endemic.
The objective of investigations is to identify patients with targeted MDROs and address gaps in detection or infection control that could facilitate transmission. Broad point preva- lence surveys may be used to bridge traditional “containment” response and prevention activities. 1. Initial response measures facilitate prompt imple- mentation of appropriate IPC measures for contact precautions for the patient at the facility where they are currently admitted, to prevent transmission: • Healthcare facilities should ensure implementa- tion of appropriate infection control measures for contact precautions and EBP, which may vary depending on the healthcare setting. • The patient and family should be notified about the results and infection control measures. • If the MDRO was present on admission, notifica- tion of the transferring facility should occur so appropriate investigation can occur at that facility. 2. Conduct a healthcare investigation to identify health- care settings at risk of transmission from the index patient. The healthcare investigation in response to new identification of Tier 3 organisms has a narrower scope than for Tier 2 organisms. • Review the patient’s healthcare exposures prior to the positive culture to present, including overnight stays in healthcare settings. Investigations for Tier 3 organisms are generally limited to the current admission. 3. Conduct a contact investigation using colonization screening to identify individuals with targeted MDROs, to facilitate implementation of appropriate precautions and evaluate for potential transmission. • Patient screening to assess for transmission in Tier 3 is to identify colonized individuals for placement in appropriate Transmission-based Precautions. • Prioritize broader screening, such as a unit or facility-wide point prevalence survey, in the follow- ing situations: If the index patient likely acquired the MDRO in the facility. If there is other evidence or suspicion for transmis- sion on the unit such as isolates from multiple patients, an increase over baseline, or clinical case on a unit that previously had low prevalence or had not been screened. • Healthcare personnel and household contact screening, and contact screening in other settings: In the absence of known or suspected transmission from HCP or other strong epidemiologic links, HCP screening is not recommended.
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