Reference — Infection Control
Multidrug-Resistant Organisms (MDROs)
MDROs are bacteria that have developed resistance to multiple antibiotic classes, severely limiting treatment options. Nursing practice is central to MDRO prevention through consistent application of contact precautions, hand hygiene, and antibiotic stewardship advocacy.
Educational use only. Treatment options for MDROs evolve rapidly. Always consult current susceptibility testing, infectious disease specialists, and facility antibiogram data when guiding antibiotic therapy. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Quick Reference
| Organism | Precautions | Hand Hygiene | Key Feature |
|---|---|---|---|
| MRSA | Contact | ABHR or soap + water | Skin/wound colonization |
| VRE | Contact | ABHR or soap + water | Survives on surfaces weeks–months |
| ESBL | Contact | ABHR or soap + water | ESBL enzyme inactivates β-lactams |
| CRE | Contact | ABHR or soap + water | Very limited treatment options |
| C. difficile | Contact | Soap + water only | Spores — alcohol-resistant |
MRSA — Methicillin-Resistant Staphylococcus aureus
Transmission
Direct contact with skin, wounds, or drainage; indirect contact with contaminated surfaces and equipment
Precautions
Contact precautions
Required PPE
Gloves and gown on room entry; hand hygiene with ABHR (soap and water acceptable)
Room
Private room preferred; cohort with same organism if unavailable
Treatment Overview
Vancomycin (first-line for systemic infection); linezolid, daptomycin for alternatives
Decolonization
Nasal mupirocin ointment × 5 days; chlorhexidine gluconate bathing; screen and treat close contacts (surgical patients, ICU admissions at many facilities)
Nursing Considerations
- Screen high-risk patients per facility protocol (nasal swabs, wound cultures)
- Dedicated patient equipment — stethoscope, BP cuff, thermometer
- Clean and disinfect high-touch surfaces in room daily
- Educate patient and family on hand hygiene, not sharing items, wound care
- Positive MRSA screen does not mean active infection — colonization is different from infection
VRE — Vancomycin-Resistant Enterococcus
Transmission
Direct contact; indirect contact through contaminated environmental surfaces — VRE can survive on surfaces for weeks
Precautions
Contact precautions
Required PPE
Gloves and gown on room entry; hand hygiene with ABHR
Room
Private room; dedicated equipment; environmental cleaning critical due to surface survival
Treatment Overview
Linezolid or daptomycin (vancomycin is ineffective by definition); treatment options are limited
Decolonization
No established decolonization protocol; eradication from the GI tract is difficult
Nursing Considerations
- VRE can persist on dry surfaces for months — thorough environmental cleaning is essential
- Antibiotic stewardship is critical — overuse of vancomycin selects for VRE
- High-risk patients: prolonged hospitalization, prior antibiotics, immunocompromise, renal disease, liver transplant
- Screen high-risk patients per protocol (rectal swabs)
- Educate on hand hygiene importance for patients, families, and visitors
ESBL — Extended-Spectrum Beta-Lactamase-Producing Organisms
Transmission
Direct contact; fecal-oral route; contaminated surfaces; healthcare environment
Precautions
Contact precautions
Required PPE
Gloves and gown on room entry; hand hygiene with ABHR
Room
Private room preferred; cohort if unavailable
Treatment Overview
Carbapenems (imipenem, meropenem, ertapenem) for serious infections; fosfomycin for uncomplicated UTI
Decolonization
No standard decolonization protocol
Nursing Considerations
- ESBL producers include E. coli and Klebsiella — most common sources are UTIs and wounds
- Community-acquired ESBL infections are increasing — not exclusively hospital-associated
- Many ESBL strains are also resistant to fluoroquinolones and aminoglycosides
- Culture and sensitivity results are critical — do not assume coverage without susceptibility testing
- Antibiotic stewardship and hand hygiene are primary prevention strategies
CRE — Carbapenem-Resistant Enterobacteriaceae
Transmission
Direct contact; fecal-oral route; contaminated surfaces and healthcare equipment
Precautions
Contact precautions; some facilities use enhanced contact (gown and gloves for any room entry even without direct contact)
Required PPE
Gloves and gown on room entry; hand hygiene with ABHR
Room
Private room required; some facilities require enhanced environmental cleaning protocols
Treatment Overview
Ceftazidime-avibactam, meropenem-vaborbactam, imipenem-cilastatin-relebactam — options are limited and treatment must be guided by susceptibility; consult infectious disease
Decolonization
No established decolonization protocol
Nursing Considerations
- CRE (particularly KPC — Klebsiella pneumoniae carbapenemase) are among the most dangerous MDROs — few treatment options remain
- Report confirmed CRE to infection control immediately per facility protocol
- Screen high-risk patients (recent healthcare outside the US, prior MDRO history)
- Strict environmental cleaning — CRE can survive on surfaces for extended periods
- Invasive devices (urinary catheters, central lines) are major risk factors — remove as soon as possible
C. difficile — Clostridioides difficile (formerly Clostridium difficile)
Transmission
Fecal-oral route; spores survive on surfaces for months; transmitted by contaminated hands and environments
Precautions
Contact precautions
Required PPE
Gloves and gown on room entry; SOAP AND WATER (not ABHR) — alcohol does not kill spores
Room
Private room with private bathroom if possible; dedicated equipment; enhanced environmental cleaning with sporicidal agents (10% bleach solution)
Treatment Overview
Fidaxomicin (preferred) or oral vancomycin (acceptable alternative) for an initial episode; bezlotoxumab for recurrence prevention; fecal microbiota transplant (FMT) for recurrent CDI
Decolonization
No decolonization; focus on antibiotic stewardship to allow normal flora recovery
Nursing Considerations
- CRITICAL: Hand hygiene must use soap and water — ABHR is NOT effective against C. diff spores
- Environmental cleaning requires sporicidal agents (bleach-based) — standard disinfectants do not kill spores
- Antibiotic use is the #1 risk factor — any antibiotic can trigger CDI, especially clindamycin, fluoroquinolones, and cephalosporins
- Symptoms: watery diarrhea (≥3 loose stools in 24 hours), cramping, low-grade fever
- Send only liquid stool for C. diff testing — formed stool is not appropriate
- Discontinue offending antibiotic when possible
- Maintain contact precautions for the duration of the hospital stay regardless of symptom resolution
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with CDC / HICPAC · Infectious Diseases Society of America (IDSA) / SHEA. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →