A nurse is assigning rooms for clients with multidrug-resistant organisms: MRSA wound infection, VRE colonization, and CRE pneumonia. Which actions are appropriate when private rooms are limited? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Use a private room for epidemiologically important organisms such as CRE when available (Choice 4). When cohorting is necessary, place together only clients with the same organism, not MRSA, VRE, and CRE together (Choice 2). Post signs and PPE supplies and dedicate equipment or disinfect it between clients (Choice 5). Don gown and gloves before entry, remove them before exit, and perform appropriate hand hygiene (Choice 6). Mixing different MDROs or sharing equipment without disinfection promotes cross-transmission (Choices 1 and 3).
MDRO Isolation Hierarchy 1. Single private room — first choice; prioritize for CRE > VRE > MRSA 2. Cohort same organism — 2 MRSA clients together OK 3. NEVER mix different MDROs in one room — cross-colonization risk 4. Last resort: roommate with low transmission risk (no wounds, no devices, immunocompetent)
Contact Precautions PPE - Don gown + gloves before entry - Remove inside room before exit - C. difficile: soap and water (NOT alcohol-based hand rub) - Dedicate equipment (BP cuff, stethoscope, thermometer) to each client - PPE cart + signage outside the room
Pathogen Priority CRE > VRE > MRSA for private room when limited (CRE = Carbapenem-Resistant Enterobacterales — high mortality, few antibiotics)
Memory Tip "Single first; same-only cohort; never mix; soap for spores"
Bed Assignment Priority1. Private room → CRE (highest transmission/mortality)2. Next: VRE single or cohort with another VRE3. MRSA single or cohort with another MRSA4. NEVER cohort different MDROs together
Care Bundle- Don gown/gloves before entry, remove inside before exit- Soap-and-water for C. diff clients- Dedicate non-critical equipment per client- PPE cart + signage outside room
Avoid- Mixing different MDROs- Sharing BP cuff/stethoscope without disinfection- Alcohol-based hand rub for C. difficile
Multidrug-Resistant Organisms (MDROs) — Bacteria resistant to multiple antimicrobial classes. Common examples: MRSA (Methicillin-Resistant Staphylococcus aureus), VRE (Vancomycin-Resistant Enterococcus), CRE (Carbapenem-Resistant Enterobacterales — highest priority due to limited treatments and high mortality), ESBL-producing organisms, MDR-Acinetobacter, MDR-Pseudomonas. Transmission predominantly via contact; require contact precautions and rigorous environmental cleaning.
Cohorting Principles for MDROs — When private rooms are unavailable, clients with the SAME MDRO may share a room (cohorted). Different MDROs must NEVER be mixed because cross-colonization can occur (e.g., a MRSA client could acquire VRE). Priority for the limited private rooms: highest-priority pathogens first (CRE > VRE > MRSA), clients with uncontained drainage or extensive devices, immunocompromised roommates avoided. Hand hygiene, dedicated equipment, and signage are required regardless of room sharing.
Contact Precautions and PPE Technique — Required for MRSA, VRE, CRE, C. difficile, scabies, and others. Don gown and gloves BEFORE entering the room; remove gown and gloves INSIDE the room (in the designated area) before exiting to avoid contaminating the corridor. Hand hygiene immediately after PPE removal. C. difficile: soap and water hand hygiene only — alcohol-based hand rub does NOT kill spores. Dedicate non-critical equipment (BP cuff, stethoscope, thermometer) to each isolated client; if equipment must be shared, disinfect between clients per facility protocol.