What hygiene measures apply to patients with multidrug-resistant, Gram-negative pathogens that show resistance to three or four groups of antibiotics?

Based on the resistance profile and area, e.g. high-risk patients, the recommended hygiene measures vary.

Background:
The Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute (RKI) recommends adherence to basic hygiene when dealing with patients with multi-resistant Gram-negative strains with resistance to 3 of the 4 antibiotic groups (3MRGN) in normal wards. With the exception of some bacterial species, extensive hygiene measures should be observed for 3MRGNs in risk areas, e.g., in neonatology, as can be found in the corresponding recommendations. In the case of multi-resistant Gram-negative strains with resistance to 4 of the 4 antibiotic groups (4MRGNs or pan-resistance), special hygiene measures must always be implemented, i.e. basic hygiene plus isolation of patients and, if necessary, care by specially trained staff.

No recommendations have been issued yet for dealing with residents of retirement and nursing homes. Here, the KRINKO advises a separate risk assessment, as outlined in the recommendations for infection prevention in homes. However, the measures should not go beyond those that apply to MRSA-positive residents.

References:
KRINKO (2012) Hygienemaßnahmen bei Infektionen oder Besiedlung mit multiresistenten gramnegativen Stäbchen. Bundesgesundheitsbl 55:1311-1354.