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Health care  –  Interventions

Pathogen specific interventions

When patients are known or suspected to be infected or colonized with certain bacteria, additional precautions such as screening for colonization with multidrug-resistant strains, cohorting and isolation, can be implemented alongside basic guidelines. Here you find pathogen-specific interventions to help prevent and reduce occurrence of such infections.

The tables below provide a selection of resources for pathogen-specific interventions to prevent and control the spread of:

  • Gram-negative bacteria in general
  • Carbapenem-resistant Enterobacteriaceae
  • Mycobacterium tuberculosis
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • Clostridioides difficile

In addition, many countries have their own guidelines that are adapted to the local circumstances. For additional information and resources to help determine the impact of pathogen-specific interventions, go to MEASURE. See also: Basic interventions and Infection specific interventions.

Selected Resources

Gram-negative bacteria

Resource Description
Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities Global WHO guidelines for preventing and controlling three types of carbapenem-resistant gram-negative bacteria:

  • Enterobacteriaceae (CRE)
  • Acintobacter baumannii (CRAB)
  • Pseudomonas aeruginosa (CRPsA)

Includes eight recommendations, condensed by leading experts from a review of the latest evidence.

ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients These evidence-based guidelines are stratified by type of infection prevention and control intervention and species of multidrug-resistant Gram-negative bacteria and are presented in the form of ‘basic’ practices, recommended for all acute care facilities, and ‘additional special approaches’ to be considered when there is still clinical and/or epidemiological and/or molecular evidence of ongoing transmission, despite the application of the basic measures.
CDC guidelines to address gram-negative bacteria CDC’s guidelines address reducing infections caused by drug-resistant bacteria, including gram negatives.

Carbapenem-resistant Enterobacteriaceae

Resource Description
Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities Global WHO guidelines for preventing and controlling three types of carbapenem-resistant gram-negative bacteria, including carbapenem-resistant Enterobacteriaceae (CRE). Includes eight recommendations, condensed by leading experts from a review of the latest evidence.
Carbapenem-resistant Enterobacteriaceae (CRE) Directory Directory of guidance on prevention and control of carbapenem-resistant Enterobacteriaceae, published by ECDC, EU/EEA Member States, international and national agencies and professional societies.
CRE Toolkit – Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE) CDC’s Toolkit for prevention of carbapenem-resistant Enterobacteriaceae.
Acute trust toolkit for the early detection, management and control of carbapenemase-producing Enterobacteriaceae, UK (PDF) A toolkit for the early detection and prevention of spread of carbapenemase-producing Enterobacteriaceae from Public Health England.

Mycobacterium tuberculosis

Resource Description
WHO Guidelines on tuberculosis infection prevention and control, 2019 update Guidelines for infection prevention and control of tuberculosis. Provides practical and evidence-based approaches for minimizing the risk of Mycobacterium tuberculosis transmission.
TB Infection Control Information portal. Infection control program developed by CDC for tuberculosis including administrative measures, environmental controls and respiratory protective equipment.

Methicillin-resistant Staphylococcus aureus (MRSA)

Resource Description
Meticillin-resistant Staphylococcus aureus (MRSA) Directory Directory of guidance on prevention and control of MRSA, published by ECDC, EU/EEA Member States, international and national agencies and professional societies.
Methicillin-resistant Staphylococcus aureus (MRSA) Infection in Healthcare Settings CDC’s resources for prevention of MRSA infections.
Rapid screening tests for meticillin-resistant Staphylococcus aureus at hospital admission: systematic review and meta-analysis A systematic review and meta-analysis of randomized, non-randomized, and observational studies to summarize the available evidence on the effect of MRSA detection by rapid screening tests on hospital-acquired MRSA infections and acquisition rate.

Clostridioides difficile

Resource Description
Clostridium difficile infection (CDI) Directory Directory of guidance on prevention and control of C. difficile infection (CDI), published by ECDC, EU/EEA Member States, international and national agencies and professional societies.
Clostridioides difficile Infection CDC’s resources for prevention of C. difficile (C. diff) infections.
Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) Since publication of the Society for Healthcare Epidemiology of America position paper on C. difficile infection in 1995, significant changes have occurred in the epidemiology and treatment of this infection. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, and infection control and environmental management.

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World Health Organization - WHO. WHO Guidelines on tuberculosis infection prevention and control, 2019 update [Internet]. WHO. 2019 [cited 2019 Aug 13]. Available from: http://www.who.int/tb/publications/2019/guidelines-tuberculosis-infection-prevention-2019/en/
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World Health Organization - WHO. Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities [Internet]. Geneva; 2017 [cited 2017 Nov 17]. Available from: http://www.who.int/infection-prevention/publications/guidelines-cre/en/
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Centers for Disease Control and Prevention - CDC. Infection Control in Health Care Settings [Internet]. [cited 2017 Apr 24]. Available from: https://www.cdc.gov/tb/topic/infectioncontrol/default.htm
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Centers for Disease Control and Prevention - CDC. Gram-negative Bacteria Infections in Healthcare Settings - HAI [Internet]. [cited 2015 Jul 2]. Available from: http://www.cdc.gov/hai/organisms/gram-negative-bacteria.html
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Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol [Internet]. 2010 May;31(5):431–55. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20307191
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Tacconelli E, Cataldo MA, Dancer SJ, De Angelis G, Falcone M, Frank U, et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect [Internet]. 2014 Jan;20 Suppl 1:1–55. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24329732
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European Centre for Disease Prevention and Control - ECDC. MRSA: Guidance on infection prevention and control [Internet]. [cited 2015 May 4]. Available from: http://ecdc.europa.eu/en/healthtopics/Healthcare-associated_infections/guidance-infection-prevention-control/Pages/guidance-prevention-control-infections-MRSA.aspx
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European Centre for Disease Prevention and Control - ECDC. CRE: Guidance on infection prevention and control [Internet]. [cited 2015 May 4]. Available from: http://ecdc.europa.eu/en/healthtopics/Healthcare-associated_infections/guidance-infection-prevention-control/Pages/guidance-prevention-control-infections-CRE.aspx
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European Centre for Disease Prevention and Control - ECDC. CDI: Guidance on infection prevention and control [Internet]. [cited 2015 May 4]. Available from: http://ecdc.europa.eu/en/healthtopics/Healthcare-associated_infections/guidance-infection-prevention-control/Pages/guidance-prevention-control-infections-CDI.aspx
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Tacconelli E, De Angelis G, de Waure C, Cataldo MA, La Torre G, Cauda R. Rapid screening tests for meticillin-resistant Staphylococcus aureus at hospital admission: systematic review and meta-analysis. Lancet Infect Dis [Internet]. 2009 Sep;9(9):546–54. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19695491
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Public Health England. Acute trust toolkit for the early detection, management and control of carbapenemase-producing Enterobacteriaceae [Internet]. National Health System; 2013 [cited 2014 Aug 19]. Available from: http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317140378646