Additional Precautions Personal Protective Equipment (PPE) Gloves Gown* Mask* Individuals in Contact Precautions do not require PPE when leaving their room * Gown and mask use is determined by risk assessment and the level of care being provided to the client/patient/resident In acute care settings: Contact Precautions for MRSA and VRE in acute care include: • Hand hygiene as described in Routine Practices (refer to Appendix D, “PIDAC’S Hand Hygiene Fact Sheet for Health Care Settings”); • Appropriate patient placement, i.e. single room or cohorting of patients. • Gloves for entering the patient’s room or bed space; • Long-sleeved gown for entering patient’s room or bedspace of any patient who has, or is suspected of having, infection or colonization with MRSA or VRE. • Hand hygiene by the patient before leaving his/her room; • Dedicated use of equipment or adequate cleaning and disinfecting of shared equipment. In non-acute care settings, including non-acute facilities, ambulatory settings and home health care: Contact Precautions for MRSA and VRE in non-acute care include: • Hand hygiene as described in Routine Practices (refer to Appendix D,” PIDAC’s Hand Hygiene Fact Sheet for Health Care Settings”); • Appropriate client/patient/resident placement (e.g. single room, cohort) on a case-by-case basis, assessed by a multidisciplinary team; • Gloves for direct care (see glossary for definition of “direct care”); • Long-sleeved gown for direct care and when clothing/skin may become contaminated (e.g. room of resident who soils the environment); • Hand hygiene for the client/patient/resident on presentation and departure from an ambulatory/clinic setting9; • Dedicated use of equipment or adequate cleaning and disinfecting of shared equipment (e.g. chair, couch). Covering the chair/couch with a disposable or washable sheet before each attendance by a VRE-colonized client/patient/resident may reduce cleaning requirements after use. Photo credit:: Centers for Disease Control and Prevention

Additional Precautions Environment and Equipment Dedicated equipment Review cleaning and disinfection methods Routine management of linens Curtains should be removed and laundered when soiled and after discharge of clients/patients/residents with VRE (consideration of above for individual with MRSA) Both VRE and MRSA have been isolated from various health care surfaces including door handles, hydrotherapy tubs, gowns and linens, hospital furnishings, patient charts, tourniquets, call bells, telephones, computer keyboards, faucets and medical equipment such as glucose meters, blood pressure cuffs, electronic thermometers and intravenous fluid pumps. Equipment within a cohort of known positive patients can be utilized by all patients in the cohort, but must be adequately cleaned and disinfected between each patient as described under Routine Practices. Hospital grade disinfectants are active against both MRSA and VRE and general routine cleaning and disinfection methods are adequate for dealing with MRSA. However, routine cleaning may not be adequate to remove VRE from contaminated surfaces. Studies have shown that surface cultures for VRE remain positive when a cloth is dipped back into cleaning solution after use and re-used on another surface; when supplies in the room are re-used after discharge; when there is insufficient contact time between the disinfectant solution and the surface being cleaned; and when surfaces are sprayed and wiped, rather than actively scrubbed. There has also been reported success in ending an outbreak of VRE using intensive environmental disinfection with twice-daily cleaning.

Additional Precautions Visitors Visitors should wear the same PPE as healthcare workers Visitors must receive education regarding hand hygiene and the appropriate use of PPE Although visitors have not been implicated in the transmission of MRSA or VRE in health care facilities, all persons entering and leaving a client/patient/resident’s room require instruction regarding how to enter and leave the room safely when the client/patient/resident is on Contact Precautions for MRSA or VRE. This should include demonstration in putting on and taking off PPE, hand hygiene and disposal of linen and garbage. PPE use by a visitor must be appropriate to the type of interaction they will have with the client/patient/resident.