PRE-PLANNING ACTIVITY – NP1
This activity is designed to enhance your clinical knowledge and experience. Students are required to
complete this pre planning clinical assignment focused on safe patient care and turn in to the clinical
faculty at pre-conference. This assignment counts as two (2) hours of pre planning clinical hours as
reported to the Oklahoma Board of Nursing (OBN). Failure to complete this assignment will result in a
clinical absence and the student will not able to attend clinical.
Please use your course textbooks as your primary source. Credible, scientific and professional websites
and texts are also acceptable. Please list the references you utilized in the space provided at the end of
the activity.
Infection Control and MDROs
1. What is a Healthcare-Associated Infection (HAI)? How prevalent are they?
“Health care-associated infections (HCAIs) are infections that occur while receiving health care, developed
in a hospital or other health care facility that first appear 48 hours or more after hospital admission, or
within 30 days after having received health care. Multiple studies indicate that the common types of
adverse events affecting hospitalized patients are adverse drug events, HCAIs, and surgical complications.
The US Center for Disease Control and Prevention identifies that nearly 1.7 million hospitalized patients
annually acquire HCAIs while being treated for other health issues and that more than 98,000 patients (one
in 17) die due to these.”
Infect Drug Resist. 2018; 11: 2321–2333.
2. What patients are at high-risk for getting an infection while in the hospital?
“Alongside infections due to cross-contamination between patients and health workers, patients being
susceptible to common infections due to diminished immune responses, and infections at surgery sites
(SSIs), many HCAIs are due to implants and prostheses. These include central line-associated bloodstream
infections (CLABSIs), catheter-associated UTIs, and ventilator-associated pneumonia (VAP).”
Infect Drug Resist. 2018; 11: 2321–2333.
3. Reference the following document from the CDC: Management of Multidrug-Resistant
Organisms (MDROs) in Healthcare Settings. What is the CDC’s definition of a MDRO? Give 2
examples of organisms classified as MDROs.
“For epidemiologic purposes, MDROs are defined as microorganisms, predominantly bacteria, that are
resistant to one or more classes of antimicrobial agents (1). Although the names of certain MDROs describe
resistance to only one agent (e.g., MRSA, VRE), these pathogens are frequently resistant to most available
antimicrobial agents.”
, “In addition to Escherichia coli and Klebsiella pneumoniae, these include strains of Acinetobacter
baumannii resistant to all antimicrobial agents, or all except imipenem, (6-12), and organisms such as
Stenotrophomonas maltophilia (12-14), Burkholderia cepacia (15, 16), and Ralstonia pickettii (17) that are
intrinsically resistant to the broadest-spectrum antimicrobial agents. In some residential settings (e.g.,
LTCFs), it is important to control multidrug-resistant S. pneumoniae (MDRSP) that are resistant to
penicillin and other broad-spectrum agents such as macrolides and fluroquinolones (18, 19). Strains of S.
aureus that have intermediate susceptibility or are resistant to vancomycin (i.e., vancomycin-intermediate
S. aureus [VISA], vancomycin-resistant S. aureus [VRSA]) (20-30) have affected specific populations, such
as hemodialysis patients.”
4. MRSA is one of the most common MDROs. What does MRSA stand for? What diagnostic
studies are used to detect MRSA in patients?
“MRSA stands for methicillin-resistant Staphylococcus aureus, a type of bacteria that is resistant to several
antibiotics.”. https://www.cdc.gov/mrsa/community/index.html
“In addition to broth microdilution testing, the Clinical and Laboratory Standards Institute (CLSI),
recommends the cefoxitin disk diffusion test or a plate containing 6 μg/ml of oxacillin in Mueller-Hinton
agar supplemented with 4% NaCl as alternative methods of testing for MRSA. For specific details on these
methods, see CLSI Approved Standard M100. In addition, there are FDA-approved assays for molecular
detection of the mecA gene and commercially available chromogenic agars that can be used for MRSA
detection. Finally, latex agglutination or immunochromatographic membrane tests for PBP2a can be used
to detect MRSA.” https://www.cdc.gov/mrsa/community/index.html
“Another form of MDRO surveillance is the use of active surveillance cultures (ASC) to identify patients who
are colonized with a targeted MDRO.”
“Methods for obtaining ASC must be carefully considered and may vary depending upon the MDRO of
interest. MRSA: Studies suggest that cultures of the nares identify most patients with MRSA and perirectal
and wound cultures can identify additional carriers.”
https://stacks.cdc.gov/view/cdc/49909/cdc_49909_DS1.pdf
5. The following are interventions aimed at deceasing the spread of MDROs (Standard and
Contact Precautions). Give a description of how the intervention would be performed for a
patient with an MDRO and give a rationale for each intervention:
Intervention
Description and Rationale
Rationale: “Keeping your hands clean is one of the most important steps you can take to
avoid getting sick and spreading germs like MRSA.”
Hand Hygiene “Use soap and water to clean your hands if available. After wetting your hands and adding
soap, scrub your hands for at least 20 seconds. If you cannot access soap and water, use an
alcohol-based hand sanitizer that contains at least 60% alcohol to clean hands. Apply the
sanitizer to one hand, rub your hands together, trying to cover all surfaces of your hands and
2
This activity is designed to enhance your clinical knowledge and experience. Students are required to
complete this pre planning clinical assignment focused on safe patient care and turn in to the clinical
faculty at pre-conference. This assignment counts as two (2) hours of pre planning clinical hours as
reported to the Oklahoma Board of Nursing (OBN). Failure to complete this assignment will result in a
clinical absence and the student will not able to attend clinical.
Please use your course textbooks as your primary source. Credible, scientific and professional websites
and texts are also acceptable. Please list the references you utilized in the space provided at the end of
the activity.
Infection Control and MDROs
1. What is a Healthcare-Associated Infection (HAI)? How prevalent are they?
“Health care-associated infections (HCAIs) are infections that occur while receiving health care, developed
in a hospital or other health care facility that first appear 48 hours or more after hospital admission, or
within 30 days after having received health care. Multiple studies indicate that the common types of
adverse events affecting hospitalized patients are adverse drug events, HCAIs, and surgical complications.
The US Center for Disease Control and Prevention identifies that nearly 1.7 million hospitalized patients
annually acquire HCAIs while being treated for other health issues and that more than 98,000 patients (one
in 17) die due to these.”
Infect Drug Resist. 2018; 11: 2321–2333.
2. What patients are at high-risk for getting an infection while in the hospital?
“Alongside infections due to cross-contamination between patients and health workers, patients being
susceptible to common infections due to diminished immune responses, and infections at surgery sites
(SSIs), many HCAIs are due to implants and prostheses. These include central line-associated bloodstream
infections (CLABSIs), catheter-associated UTIs, and ventilator-associated pneumonia (VAP).”
Infect Drug Resist. 2018; 11: 2321–2333.
3. Reference the following document from the CDC: Management of Multidrug-Resistant
Organisms (MDROs) in Healthcare Settings. What is the CDC’s definition of a MDRO? Give 2
examples of organisms classified as MDROs.
“For epidemiologic purposes, MDROs are defined as microorganisms, predominantly bacteria, that are
resistant to one or more classes of antimicrobial agents (1). Although the names of certain MDROs describe
resistance to only one agent (e.g., MRSA, VRE), these pathogens are frequently resistant to most available
antimicrobial agents.”
, “In addition to Escherichia coli and Klebsiella pneumoniae, these include strains of Acinetobacter
baumannii resistant to all antimicrobial agents, or all except imipenem, (6-12), and organisms such as
Stenotrophomonas maltophilia (12-14), Burkholderia cepacia (15, 16), and Ralstonia pickettii (17) that are
intrinsically resistant to the broadest-spectrum antimicrobial agents. In some residential settings (e.g.,
LTCFs), it is important to control multidrug-resistant S. pneumoniae (MDRSP) that are resistant to
penicillin and other broad-spectrum agents such as macrolides and fluroquinolones (18, 19). Strains of S.
aureus that have intermediate susceptibility or are resistant to vancomycin (i.e., vancomycin-intermediate
S. aureus [VISA], vancomycin-resistant S. aureus [VRSA]) (20-30) have affected specific populations, such
as hemodialysis patients.”
4. MRSA is one of the most common MDROs. What does MRSA stand for? What diagnostic
studies are used to detect MRSA in patients?
“MRSA stands for methicillin-resistant Staphylococcus aureus, a type of bacteria that is resistant to several
antibiotics.”. https://www.cdc.gov/mrsa/community/index.html
“In addition to broth microdilution testing, the Clinical and Laboratory Standards Institute (CLSI),
recommends the cefoxitin disk diffusion test or a plate containing 6 μg/ml of oxacillin in Mueller-Hinton
agar supplemented with 4% NaCl as alternative methods of testing for MRSA. For specific details on these
methods, see CLSI Approved Standard M100. In addition, there are FDA-approved assays for molecular
detection of the mecA gene and commercially available chromogenic agars that can be used for MRSA
detection. Finally, latex agglutination or immunochromatographic membrane tests for PBP2a can be used
to detect MRSA.” https://www.cdc.gov/mrsa/community/index.html
“Another form of MDRO surveillance is the use of active surveillance cultures (ASC) to identify patients who
are colonized with a targeted MDRO.”
“Methods for obtaining ASC must be carefully considered and may vary depending upon the MDRO of
interest. MRSA: Studies suggest that cultures of the nares identify most patients with MRSA and perirectal
and wound cultures can identify additional carriers.”
https://stacks.cdc.gov/view/cdc/49909/cdc_49909_DS1.pdf
5. The following are interventions aimed at deceasing the spread of MDROs (Standard and
Contact Precautions). Give a description of how the intervention would be performed for a
patient with an MDRO and give a rationale for each intervention:
Intervention
Description and Rationale
Rationale: “Keeping your hands clean is one of the most important steps you can take to
avoid getting sick and spreading germs like MRSA.”
Hand Hygiene “Use soap and water to clean your hands if available. After wetting your hands and adding
soap, scrub your hands for at least 20 seconds. If you cannot access soap and water, use an
alcohol-based hand sanitizer that contains at least 60% alcohol to clean hands. Apply the
sanitizer to one hand, rub your hands together, trying to cover all surfaces of your hands and
2
