Managing MDROs (MRSA/VRE) in Congregate Living Settings

You just got the call. A resident tested positive for MRSA. Or maybe it’s VRE this time. Either way, you’re staring at a lab report, wondering what happens next.

Do you isolate immediately? What about the roommate? Should you notify families? And what exactly do you tell staff who are already nervous about working the unit?

Welcome to one of the most stressful situations in congregate living management. Multidrug-resistant organisms aren’t just clinical challenges—they’re regulatory minefields, family relations tests, and staff morale issues all rolled into one.

But here’s the good news. With the right approach, MDROs are entirely manageable. We’ve helped dozens of Canadian long-term care facilities, retirement homes, and group homes navigate these exact situations. And we’re going to walk you through what actually works.

No academic jargon. No impossible protocols designed for hospitals with unlimited resources. Just practical strategies for real-world congregate settings.

Let’s start with what you need to know right now.

MDRO Basics: What You’re Actually Dealing With

MRSA and VRE are the two MDROs you’ll encounter most often in congregate living.

MRSA (Methicillin-Resistant Staphylococcus Aureus) is a staph bacterium resistant to common antibiotics. It typically colonizes the nose, throat, or skin. In healthy people, it often causes no problems. In vulnerable residents, it can lead to skin infections, pneumonia, or bloodstream infections.

VRE (Vancomycin-Resistant Enterococcus) is an intestinal bacterium that has developed resistance to vancomycin, one of our last-line antibiotics. It colonizes the gastrointestinal tract and can cause urinary tract infections, bloodstream infections, or wound infections.

Here’s the crucial distinction many people miss: colonization is not infection.

A colonized resident carries the organism but shows no signs of illness. They’re not sick. They don’t need antibiotics. But they can still transmit the organism to others.

An infected resident has an actual illness caused by the organism. Symptoms. Clinical signs. This is when treatment becomes necessary.

Why does this matter? Because most MDRO-positive residents are colonized, not infected. Treating colonization with antibiotics doesn’t work and actually worsens antibiotic resistance. Yet we see facilities making this mistake constantly.

Why Congregate Settings Are Particularly Vulnerable

Hospitals deal with MDROs, too. But congregate living settings face unique challenges that make management trickier.

Shared spaces are unavoidable. Residents eat together. Participate in activities together. Share bathrooms in some settings. Unlike hospital patients who stay in their rooms, congregate living residents move around. That’s the whole point—it’s their home.

Isolation rooms are limited. Most facilities have few true private rooms. You can’t isolate everyone who tests positive without essentially shutting down the facility.

Residents have varying cognitive abilities. A resident with dementia can’t reliably maintain hand hygiene or respect contact precautions. They wander. They touch surfaces. They enter other residents’ rooms.

Staff work across multiple residents. Personal support workers provide care to 8, 10, sometimes 12 residents per shift. Each interaction is a potential transmission opportunity if protocols aren’t followed perfectly.

Resources are constrained. You don’t have infection control practitioners on every shift. PPE budgets are tight. Staffing ratios are stretched.

Quality of life matters deeply. These are people’s homes. Isolating someone for weeks or months has profound impacts on mental health, dignity, and wellbeing. You can’t just prioritize infection control over everything else.

All of this means cookie-cutter hospital protocols don’t translate well. You need approaches designed specifically for congregate settings.

What To Do When Someone Tests Positive: Your Immediate Action Plan

Let’s get practical. A resident’s lab results just came back positive for MRSA or VRE. What now?

Step 1: Verify the Results and Clinical Context

Don’t panic. First, confirm what you’re dealing with.

Check the lab report. Is this a screening swab (surveillance) or a clinical culture from an infection site? Was the resident symptomatic, or was this routine admission screening?

A positive screening swab means colonization. A positive culture from a wound, blood, or urine with clinical symptoms means infection.

This distinction drives your response. Colonization requires contact precautions to prevent transmission. Infection requires those same precautions plus appropriate treatment.

Step 2: Implement Contact Precautions Immediately

Start contact precautions right away. Don’t wait for the morning meeting or the policy committee review.

Contact precautions mean:

• Gloves and gown for all entry into the resident’s room or care area
• Hand hygiene before and after resident contact
• Dedicated equipment when possible (blood pressure cuffs, stethoscopes, thermometers)
• Enhanced environmental cleaning

If the resident has a private room, great. Use it. If not, you’ll need to consider cohorting (more on that shortly).

Post signage outside the room indicating contact precautions. Make sure all staff—including dietary, housekeeping, and maintenance—understand the requirements.

Step 3: Assess Infection vs. Colonization

If the resident shows signs of infection, notify the physician immediately. Symptoms vary by site but might include:

• Wound infections: Redness, warmth, drainage, increased pain
• Urinary tract infections: Dysuria, frequency, fever, confusion
• Pneumonia: Cough, fever, difficulty breathing, chest pain
• Bloodstream infections: Fever, chills, hypotension, altered mental status

Infected residents need medical assessment and likely antibiotic therapy based on culture sensitivities. But remember—antibiotics treat infections, not colonization.

Step 4: Notify Required Parties

Your notification list includes:

Public Health: Check provincial requirements. Most jurisdictions require reporting MDRO outbreaks (two or more epidemiologically linked cases) but not individual cases. Know your local rules.

Medical Director/Attending Physician: They need to know for care planning and potential treatment decisions.

Family/Substitute Decision Maker: This gets delicate. You need to inform them, but in a way that doesn’t cause unnecessary alarm. We’ll cover communication strategies shortly.

Unit Staff: Everyone providing care needs to know about precautions. Share information in huddles, shift reports, and posted alerts.

Roommate’s Family (if applicable): If the resident shares a room, the roommate’s family should know. They’ll likely find out anyway, and transparency builds trust.

Step 5: Review and Enhance Routine Practices

Contact precautions don’t replace routine practices—they augment them. This is a good time to reinforce:

• Hand hygiene at all four moments
• Proper PPE donning and doffing technique
• Environmental cleaning protocols
• Linen handling procedures
• Waste management

Often, MDRO transmission happens not because contact precautions failed, but because basic routine practices were inconsistent.

The Cohorting Dilemma: When Isolation Isn’t Possible

Here’s a reality most guidelines gloss over: you often don’t have enough private rooms for everyone who needs precautions.

So what do you do when you have three MRSA-positive residents and one isolation room?

Cohorting means grouping residents with the same organism together. It’s not ideal, but it’s pragmatic.

How to Cohort Safely

Only cohort residents with the SAME organism. Never put MRSA and VRE-positive residents together. Never mix residents with different strains if you know the strain information.

Consider cognitive and functional status. Residents who can understand and follow instructions make better cohort candidates. Two cognitively intact residents who can maintain some hand hygiene are at lower risk than pairing someone with dementia who wanders.

Maintain spatial separation. Even in shared rooms, maximize distance between beds. Use privacy curtains consistently (and clean them frequently).

Continue contact precautions. Cohorting doesn’t mean you can skip PPE. Staff still use gloves and gowns for each resident contact.

Dedicated equipment stays dedicated. Each resident keeps their own toileting equipment, thermometers, and blood pressure cuffs when possible.

Clean between residents. If staff move from one cohorted resident to another, they perform hand hygiene and change PPE between residents.

Is cohorting as good as private rooms? No. But it’s far better than having no precautions at all because you’re overwhelmed.

The Alternative: Risk-Based Decision Making

Some situations call for modified precautions. This is controversial, but hear us out.

A fully continent, cognitively intact resident colonized with MRSA (not infected) who maintains good hand hygiene poses a different risk than an incontinent resident with dementia who requires full assistance.

Some facilities use risk-based approaches:

• High-risk residents (incontinent, wounds, cognitive impairment): Full contact precautions
• Low-risk residents (continent, intact skin, cognitively well): Modified precautions with enhanced hand hygiene and monitoring

This isn’t standard practice, and you need to document your rationale carefully. Discuss with your medical director and IPAC leads. But rigid protocols that ignore individual circumstances sometimes create worse outcomes.

Staff Education: Addressing Fear Without Causing Panic

Let’s talk about the staff meeting where you announce an MDRO case.

You can feel the tension immediately. Some staff members get quiet. Others start asking if they should work on the unit. Someone mentions the news story about a superbug outbreak.

How you handle this moment matters enormously.

What Staff Actually Need to Know

Start with reassurance grounded in facts. MRSA and VRE don’t pose a significant risk to healthy healthcare workers following routine practices. Millions of healthcare workers care for MDRO-positive patients daily without getting infected.

Explain colonization vs. infection clearly. Many staff assume positive results mean severe illness. Clarify that most positive residents are colonized, not sick, and pose minimal risk with proper precautions.

Emphasize what they’re already doing. Good hand hygiene, which they already practice, is the single most important protective measure. This isn’t about learning entirely new skills.

Be specific about precautions. Vague instructions create anxiety. Clear protocols create confidence. Show them exactly what gown and gloves to use. Demonstrate proper donning and doffing. Practice with them.

Address the “what if I bring it home” concern. Staff worry about transmitting MDROs to family members. Explain that proper hand hygiene and changing clothes before leaving work are protective. Healthcare workers don’t have higher MDRO colonization rates than the general population when following basic practices.

Acknowledge their concerns without validating misconceptions. “I understand this feels scary” is better than “There’s nothing to worry about” (which dismisses legitimate concerns) or “Yes, superbugs are dangerous” (which validates exaggerated fears).

Role-Specific Training

Different staff need different information.

PSWs and healthcare aides need clear, simple protocols. When to use PPE. How to provide personal care safely. What to do with contaminated linen. Keep it practical and hands-on.

Nurses need more clinical detail. Distinguishing colonization from infection. When to culture wounds. Medication administration considerations. Documentation requirements.

Housekeeping staff need enhanced cleaning protocols. Frequency of cleaning. Which disinfectants to use? High-touch surface focus. Terminal cleaning when residents are discharged or when precautions are discontinued.

Dietary staff need to understand tray handling and delivery. Disposable dishes aren’t necessary, but dedicated tray delivery and hand hygiene matter.

Maintenance workers might enter rooms rarely, but need to know about posted precautions and basic PPE use.

One-size-fits-all training misses these nuances.

Family Communication: The Conversation Nobody Wants to Have

Now the really hard part. Telling families their loved one has MRSA or VRE.

This conversation will be difficult no matter how you approach it. Families hear “resistant bacteria” and imagine worst-case scenarios.

The Initial Notification

Schedule a phone call or in-person meeting. Don’t deliver this news via letter or posted notice if you can avoid it.

Start with context: “I’m calling to let you know that routine screening/a recent test showed that your mother has MRSA bacteria. I want to explain what this means and answer your questions.”

Explain colonization vs. infection immediately. Most families don’t know the difference. If their loved one is colonized but not infected, emphasize this right away. “She’s not sick from this. Her body is simply carrying bacteria that many people carry without any problems.”

Describe what you’re doing. Families want to know their loved one is receiving appropriate care. Outline the precautions: “We’re using gowns and gloves when providing care. We’re cleaning her room more frequently. We’re monitoring her closely for any signs of infection.”

Address transmission concerns. Families immediately worry about visiting. Reassure them: “You can absolutely still visit. You’ll need to use hand hygiene when entering and leaving. In some cases, we may ask you to wear a gown and gloves during close contact, and we’ll show you how to use these properly.”

Acknowledge the emotional impact. “I know this is concerning news. It’s normal to feel worried. We’re here to support both you and your mother through this.”

Provide written information. Have fact sheets ready about MRSA/VRE. Include reputable sources that families can consult (Public Health Ontario has excellent resources).

Handling Common Family Questions

“How did she get this?” Honest answer: Often, we don’t know. Many people are already colonized on admission. Others acquire it from environmental exposure. This isn’t about blaming anyone or identifying a failure.

“Can this be cured?” Complicated answer: Colonization isn’t treated because antibiotics don’t eliminate it and may worsen resistance. If infection develops, we treat the infection, but colonization often persists. Some people clear colonization spontaneously over time; others remain colonized long-term.

“Is she going to die from this?” Reassuring but realistic answer: Most colonized people never develop an infection. Even if infection occurs, it’s usually treatable, though treatment may require stronger antibiotics. MRSA and VRE are serious, but they’re manageable with proper care.

“Should we move her to another facility?” Firm but kind answer: Most facilities have MDRO-positive residents. Moving wouldn’t eliminate risk and might be disruptive to her care and well-being. We’re managing this appropriately with evidence-based precautions.

“What about the other residents?” Transparent answer: We’re taking precautions to prevent transmission. Other residents and their families are being monitored. We follow all required notification protocols.

Ongoing Communication

Don’t make this a one-time conversation. Follow up regularly.

Update families if status changes if infection develops, if precautions are discontinued, if screening shows clearance.

Invite questions at any time. Some families need a few days to process before their real concerns surface.

Include families in care planning. If isolation affects their loved one’s mental health or quality of life, discuss modifications that balance safety and wellbeing.

Environmental Cleaning: The Unsexy But Crucial Element

Let’s talk about cleaning. Everyone wants to skip this section. Don’t.

Environmental contamination plays a significant role in MDRO transmission. Organisms can survive on surfaces for days, weeks, or even months, depending on conditions.

Daily Cleaning Requirements

For rooms with contact precautions, clean high-touch surfaces at least twice daily. High-touch means:

• Bed rails
• Call bells
• Light switches
• Door handles
• Bedside tables
• Wheelchair armrests
• Bathroom fixtures (especially toilet and sink)
• IV poles or other equipment

Use hospital-grade disinfectants with appropriate contact time. The product sitting on the surface for 30 seconds doesn’t work if the label requires a 1-minute contact time.

Clean from cleanest to dirtiest areas. Don’t use the same cloth on the bedside table that you just used on the toilet.

Terminal Cleaning

When a resident is discharged, transferred, or contact precautions are discontinued, perform terminal cleaning.

This means everything. Every surface. Every piece of furniture. Every item in the room. It’s time-consuming, but it’s necessary.

Remove and launder curtains, including privacy curtains around beds. Replace items that can’t be cleaned adequately. Inspect for damaged furniture or equipment where organisms might harbor.

Document terminal cleaning completion before another resident moves in.

Shared Spaces Present Challenges

Dining rooms, activity areas, and lounges can’t be cleaned after every MDRO-positive resident uses them. That’s not realistic.

Instead:

• Clean high-touch surfaces in shared spaces at least twice daily
• Clean immediately after known spills or contamination
• Consider timing activities so MDRO-positive residents participate either early (allowing cleaning before others) or late (requiring only end-of-day terminal cleaning)
• Ensure residents perform hand hygiene before meals and activities

Pragmatism beats perfection here. Don’t let perfect protocols prevent reasonable risk reduction.

Screening: Who, When, and Why

Screening protocols vary widely. Some facilities screen everyone on admission. Others only screen high-risk residents. Some don’t screen at all unless clinical suspicion arises.

What’s right?

Admission Screening

Arguments for universal admission screening:

• Identifies colonized residents early
• Allows immediate implementation of precautions
• Prevents unrecognized transmission
• Some provincial regulations require it

Arguments against:

• Cost (laboratory testing isn’t free)
• May identify colonization that never causes problems
• Positive results can lead to unnecessary isolation
• Resources might be better spent on robust routine practices

Our take? Risk-based admission screening makes sense for most facilities. Screen residents who:

• Are transferring from hospitals (especially if recent hospitalization >48 hours)
• Have a history of prior MDRO colonization/infection
• Have chronic wounds or indwelling devices
• Have recent antibiotic exposure
• Are coming from facilities with known MDRO outbreaks

Ongoing Surveillance

Point prevalence surveys, screening all residents on a unit or throughout a facility on a single day, can identify unrecognized colonization.

Consider prevalence surveys:

• Annually, as baseline surveillance
• When investigating potential outbreaks
• After implementing new prevention initiatives to assess impact

Don’t survey so frequently that you’re constantly finding new positive cases without the capacity to manage them appropriately.

When to Discontinue Precautions

This question comes up constantly. Can precautions ever stop?

Some facilities maintain contact precautions indefinitely once someone tests positive. This is conservative but has significant quality-of-life impacts.

Others use clearance protocols: Three negative screening cultures taken at least one week apart, with no antibiotic exposure allows discontinuation of precautions.

Check your provincial guidelines. PIDAC (Public Health Ontario) provides specific recommendations that many jurisdictions follow.

Consider the individual resident. Someone colonized for three years with no transmission to others might reasonably have precautions reassessed. Someone newly colonized with active wound drainage requires continued precautions.

Document your decision-making process regardless of which approach you take.

Outbreak Management: When One Case Becomes Many

You’ve got three MRSA cases on the same unit in two weeks. Is this an outbreak?

Probably. Most jurisdictions define outbreaks as two or more epidemiologically linked cases within a specified timeframe.

Declaring an Outbreak

Don’t delay outbreak declaration, hoping cases will stop appearing. Early declaration allows faster response.

Notify your local public health unit immediately. They’ll help determine whether you’re meeting outbreak criteria and guide your response.

Convene your outbreak management team. This typically includes the administration, medical director, the IPAC lead, and the unit managers.

Enhanced Control Measures

During outbreaks, ramp up everything:

Surveillance: Screen all unit residents for the organism. This identifies unrecognized cases, allowing appropriate precautions.

Cohorting: Group positive residents together. Dedicate staff to the cohort if possible (though this strains staffing).

Communication: Notify all families in the affected unit. Daily updates during active outbreaks maintain trust.

Auditing: Increase hand hygiene and cleaning audits. Identify where breakdowns are occurring.

Restrictions: Consider limiting new admissions to the unit, canceling group activities, and restricting transfers between units.

Environmental assessment: Evaluate potential contamination sources. Is there damaged furniture harboring organisms? Plumbing issues? Shared equipment not being cleaned between uses?

Education blitz: Reinforcement training for all staff. Competency validation. Sometimes transmission continues because a few staff members aren’t following protocols correctly.

Resolving the Outbreak

Outbreaks end when you’ve had no new cases for a defined period—usually two incubation periods for the organism.

Don’t declare victory prematurely. We’ve seen facilities stop enhanced measures after a week without new cases, only to have another case appear immediately after.

Public health will guide outbreak resolution. Document everything throughout the outbreak for their review and your records.

Conduct a post-outbreak debrief. What worked? What didn’t? How can you prevent recurrence? Share learnings with all staff.

Balancing Infection Control with Quality of Life

Here’s the uncomfortable truth: strict isolation protocols harm residents.

Social isolation increases depression, anxiety, and cognitive decline in elderly individuals. Residents on contact precautions receive less healthcare worker time. They participate in fewer activities. Family visits may decrease.

These aren’t minor concerns. They’re significant quality of life impact.

So how do you balance infection control with dignity and well-being?

Consider the Least Restrictive Approach

Ask: What’s the minimum level of precaution that adequately protects others while maximizing this resident’s quality of life?

For a cognitively intact, continent resident with MRSA colonization, do they really need to be excluded from all group activities? Or can they participate with hand hygiene before and after, plus enhanced environmental cleaning?

Can they eat in the dining room at a table by themselves rather than isolated in their room?

Can they attend chapel services if they sit in a designated area and leave first, allowing cleaning before others disperse?

These aren’t standard recommendations. You need to assess each situation individually and document your risk-benefit analysis.

Involve Residents in Decision-Making

When cognitively able, residents should participate in decisions about their care.

Explain the situation honestly. “You have bacteria that could spread to others if we’re not careful. We’re recommending you stay in your room during mealtimes. But we want to know—what matters most to you? How can we make this less isolating?”

Some residents prefer caution. Others are willing to accept modifications that allow more social participation.

Respect their autonomy while being clear about risks.

Creative Solutions

We’ve seen facilities implement creative approaches:

• Virtual activity participation (tablets in rooms for residents to join group programs remotely)
• Scheduled outdoor time (easier to maintain distance, fresh air benefits wellbeing)
• Designated activity times (resident participates first or last, allowing cleaning)
• One-on-one visits from activities staff in residents’ rooms
• Pet therapy visits to isolated residents
• Family video calls when in-person visits are difficult

None of these appear in official guidelines. But they reflect person-centered care that values residents as individuals, not just infection control challenges.

Regulatory Compliance: What Inspectors Actually Look For

Let’s be practical about inspections. When the ministry arrives, what are they checking?

Policy and Procedures

You need written protocols for:

• MDRO screening on admission
• Implementation of contact precautions
• Management of outbreaks
• Communication with Public Health
• Staff education and competency validation
• Environmental cleaning standards
• Discontinuation of precautions

Policies sitting in a binder don’t count. Can staff access them easily? Do they reflect actual practice? Are they reviewed and updated regularly?

Documentation

Inspectors want to see:

• Screening results and dates
• Contact precaution start dates
• Communication logs with families and Public Health
• Staff education records
• Hand hygiene audit results
• Environmental cleaning checklists
• Outbreak management documentation

Missing documentation suggests protocols aren’t being followed, even if they are.

Actual Practice

The best policies mean nothing if practice doesn’t match.

Inspectors observe: Are staff actually wearing appropriate PPE? Is signage posted correctly? Are hand sanitizer dispensers stocked and accessible?

They interview staff: Can staff explain when and how to use contact precautions? Do they understand the difference between routine practices and additional precautions?

They review outcomes: What are your MDRO rates? Have you had outbreaks? How were they managed?

Common Deficiencies

We see the same issues repeatedly:

• Inadequate admission screening
• Delayed implementation of precautions after positive results
• Inconsistent PPE use by staff
• Poor hand hygiene compliance
• Insufficient staff education
• Failure to notify Public Health during outbreaks
• Missing or incomplete documentation

All of these are fixable. But you need to identify gaps before inspectors do.

When to Call for Expert Help

Some situations exceed internal capacity. There’s no shame in recognizing when you need support.

Consider bringing in IPAC consulting expertise when:

You’re facing an active outbreak, and internal resources are overwhelmed. External consultants can rapidly assess the situation, identify transmission sources, and implement control measures.

Inspection found significant deficiencies in your MDRO management. You need to correct these quickly and demonstrate improvement to regulators.

Your facility is opening or expanding, and you’re developing IPAC programs from scratch. Getting protocols right from the beginning prevents problems down the road.

Staff resistance is preventing protocol implementation. Sometimes, external experts provide credibility that internal staff don’t have. We can deliver education and support behavior change.

You lack dedicated IPAC expertise. Many smaller facilities don’t have trained infection control practitioners. Consultants fill this gap, providing assessments, policy development, and ongoing guidance.

You’re preparing for accreditation and want to ensure MDRO protocols meet standards.

At Infection Shield, we work extensively with Canadian congregate living facilities on MDRO management. We understand the unique challenges you face, limited resources, quality of life considerations, and complex regulations.

We don’t drop in with hospital-based protocols that don’t fit your reality. We develop practical, sustainable solutions tailored to your specific setting.

Moving Forward: Building Sustainable MDRO Management

Managing MDROs in congregate settings isn’t a one-time project. It’s an ongoing commitment.

The best facilities don’t just react to positive cases. They build cultures where infection prevention is everyone’s responsibility.

This means leadership that prioritizes and resources IPAC initiatives. Staff who understand the “why” behind protocols and follow them consistently. Families who are partners in care rather than obstacles to overcome.

It means balancing evidence-based infection control with person-centered care that values residents’ dignity and quality of life.

It means recognizing that perfect isn’t possible, but excellent is achievable.

Your residents deserve safe care. Your staff deserve clear protocols and adequate support. Your facility deserves to operate without constant regulatory threats.

MDROs will always be part of congregate living. But with the right approach, they don’t have to dominate your daily operations or compromise quality care.

Start with solid routine practices. Add targeted interventions for high-risk situations. Train staff thoroughly. Communicate transparently. Document consistently.

And when you need support, reach out. We’re here to help.

Frequently Asked Questions

Do all MRSA or VRE-positive residents require private rooms?

Not necessarily. Private rooms are ideal when available, but cohorting residents with the same organism is acceptable when isolation rooms are limited. You can cohort MRSA-positive residents together or VRE-positive residents together (never mix different organisms). Continue contact precautions even in cohort situations. Some facilities use risk-based approaches where low-risk residents (continent, cognitively intact, no wounds) may have modified precautions, though this requires careful assessment and documentation.

How long do contact precautions need to continue?

This varies by facility policy and provincial guidelines. Some facilities maintain precautions indefinitely once someone tests positive. Others use clearance protocols—typically three negative screening cultures at least one week apart with no antibiotic exposure between tests. Check PIDAC guidelines or your provincial requirements. Consider individual circumstances: a resident colonized for years with no transmission to others might reasonably have precautions reassessed compared to someone newly colonized with active wound drainage.

Can staff work with MDRO-positive residents if they’re pregnant or immunocompromised?

Generally, yes, with proper precautions. MRSA and VRE don’t pose significantly higher risk to pregnant or immunocompromised healthcare workers compared to other workplace pathogens when routine practices and contact precautions are followed correctly. However, individual medical assessment is appropriate. Staff should consult with their healthcare providers and occupational health. The key is rigorous hand hygiene and appropriate PPE use, which protects all staff regardless of immune status.

Should we treat MRSA or VRE colonization with antibiotics?

No. This is a critical point. Colonization means the organism is present but not causing infection. Antibiotics don’t eliminate colonization and may actually worsen antibiotic resistance by killing competing bacteria that naturally suppress MDRO growth. Only treat infections when the resident shows clinical signs of illness caused by the organism. Inappropriate antibiotic use is a major driver of antimicrobial resistance. Focus on preventing transmission through hygiene and precautions rather than attempting to eliminate colonization with antibiotics.

What do we tell other residents’ families about MDRO cases in the facility?

This requires a balance between transparency and privacy. You cannot disclose which specific residents have MDROs due to privacy regulations. However, you can and should communicate generally: “We currently have residents in the facility with multidrug-resistant organisms, which is common in congregate care settings. We’re following all required infection control protocols to protect all residents.” During outbreaks affecting a specific unit, notify all families in that unit more specifically. Proactive communication builds trust; families appreciate honesty over secrecy.

Do visitors need to wear gowns and gloves?

It depends on the type of contact. For casual visits (sitting and talking), hand hygiene before entering and upon leaving is usually sufficient. If visitors will provide direct care (feeding, toileting assistance, wound care), then gowns and gloves are appropriate. Train visitors on proper donning, doffing, and hand hygiene. Most families are willing to follow precautions when you explain the rationale clearly. Provide simple written instructions and a demonstration.

Can MDRO-positive residents participate in dining room meals or group activities?

Standard recommendations often suggest room isolation during meals and activities. However, risk-based approaches may allow participation with modifications: enhanced hand hygiene, dedicated seating with spatial separation, activity timing that allows cleaning between groups, or outdoor activities where distance is easier to maintain. Consider the individual resident’s risk factors (continent vs. incontinent, cognitive status, presence of wounds), the specific activity, and your facility’s capacity for enhanced cleaning. Document your risk assessment and decision-making process.

How do we know if transmission is occurring in our facility?

Monitor several indicators: new MDRO cases in residents without prior colonization, clustering of cases on specific units or timeframes, genetic typing showing the same strain in multiple residents (though this requires specialized laboratory testing rarely done routinely). Increased MDRO rates compared to baseline suggest possible transmission. Conduct point prevalence surveys to identify unrecognized colonization. Investigate common exposures shared equipment, staff working across multiple units, and environmental contamination sources.

What’s the most common mistake facilities make with MDRO management?

Inconsistent adherence to routine practices, especially hand hygiene. Facilities often focus intensely on contact precautions (gowns and gloves) while overlooking the fact that proper hand hygiene before and after every resident contact is foundational. Other common issues include inadequate environmental cleaning, failure to dedicate equipment to MDRO-positive residents, delayed implementation of precautions after positive results, and insufficient staff education leading to protocol drift. The basics matter more than complex interventions.

Our facility has limited staff. How can we realistically implement all these protocols?

Prioritize what matters most. Excellent hand hygiene and routine practices prevent more transmission than perfect but inconsistently followed complex protocols. Use cohorting to reduce PPE and staffing burden. Engage staff in problem-solving; they often identify practical workflow solutions. Ensure adequate PPE supplies are conveniently located. Streamline documentation. Consider consulting with IPAC experts who can help design sustainable protocols for your specific staffing reality. Perfect protocols that don’t get followed help nobody; good protocols consistently implemented protect residents.