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Guideline for the Management of Antimicrobial Resistant Microorganisms in Minnesota Long-Term Care Facilities
Infectious Disease Prevention and Control Division
Health Regulation Division (formerly Facility and Provider Compliance Division)
October 2000 (Reviewed October 2004 with no changes)
- Download the full document: Guideline for the Management of Antimicrobial Resistant Microorganisms in Minnesota Long-Term Care Facilities (PDF)
Introduction:
The Minnesota Department of Health (MDH) receives many inquiries from long-term care facilities (LTCFs) regarding the placement and care of persons with antimicrobial resistant microorganisms (ARMs). The most common questions concern persons who are colonized or infected with methicillin resistant Staphylococcus aureus (MRSA) or vancomycin resistant enterococcus (VRE). Due to concern about ARMs, some LTCFs have restricted the admission of persons known to be infected or colonized with ARMs. This has caused persons with ARMs to experience delays or denial of admission to LTCFs. There is no evidence that restricting the admission of persons with ARMs is effective in keeping LTCFs free of ARMs. Because LTCF residents are not generally screened for ARMs, colonization is often not detected. Therefore, a policy restricting the admission of persons with ARMs may lead to a false sense of security that a facility is free of ARMs.
MDH Position Statement:
Based on currently available knowledge, persons with ARMs should NOT be denied LTCF admission solely on the basis of a positive ARM culture from any site. Also, it is not appropriate for LTCFs to refuse to re-admit residents who have been found to have ARMs after transfer from the LTCF to an acute care facility. New or returning residents should be admitted to LTCFs based on the ability of the facility to provide necessary care to the resident and should not be based on ARM status. Denying admission or re-admission based on ARM status alone is discriminatory and may lead to review by government agencies. The Society for Healthcare Epidemiology of America (SHEA), the American Hospital Association (AHA) task force and the Veterans' Affairs (VA) consensus panel all oppose restricting the access of MRSA colonized residents to LTCFs. Guidelines published by other states also oppose such restrictions. LTCFs should be prepared to implement appropriate infection control measures for all prospective or current residents colonized or infected with ARMs. This guideline, which is based on the best current recommendations on the subject, describes infection control measures for LTCF residents with ARMs in non-outbreak situations and is meant to supplement previously published recommendations for VRE in 1996 and MRSA in 1993. It is important to note that due to incomplete data specific to certain issues in the community LTC setting, extrapolation from studies done in other settings and/or situations has been necessary. As additional research is published, this guideline will be revised as necessary.