Effective Strategies to Prevent Multidrug-Resistant Organisms in Intensive Care Units

Multidrug-resistant (MDR) bacteria pose a significant challenge in healthcare settings, particularly in Intensive Care Units (ICUs) where patients are at high risk. Controlling and preventing the spread of MDR is a key factor in ensuring patient safety and maintaining effective treatment. This article will present comprehensive strategies to prevent multidrug-resistant bacteria in Intensive Care Units.

1. High-Risk Groups

High-risk groups for multidrug-resistant infections in Intensive Care Units include:

1.1. ICU Patients

Patients in Intensive Care Units (ICUs) are often critically ill, have weakened immune systems, and undergo numerous invasive medical procedures for diagnosis and treatment. The use of high-dose hormones and broad-spectrum antibiotics also increases the risk of hospital-acquired infections in these patients [1].

1.2. Patients with Multiple Underlying Conditions

Patients with underlying conditions such as diabetes, kidney failure, cancer, or immunodeficiency are at higher risk due to compromised immune systems [2].

1.3. Patients Using Invasive Devices

The use of invasive devices such as ventilators, urinary catheters, and central venous catheters increases entry points for pathogens, thereby increasing the drug resistance of multidrug-resistant bacteria [1, 3].

1.4. Patients with a History of MDR Infection

Patients with a history of infection or colonization with multidrug-resistant bacteria are also a high-risk group that requires close monitoring [4].

2. Signs and Consequences of Multidrug-Resistant Infections

2.1. Signs of Recognition

Signs of multidrug-resistant infections can be non-specific and similar to common infections, including fever, leukocytosis, or inflammatory signs at the infection site (e.g., redness, swelling, pain, discharge). However, the key difference is that the infection does not respond to conventional antibiotic regimens [5].

2.2. Serious Consequences

Multidrug-resistant infections lead to many serious consequences such as prolonged hospital stays, increased treatment costs, and increased morbidity and mortality. In some cases, patients may face severe complications and limited treatment options [6, 7].

3. Effective Prevention Measures

Preventing multidrug-resistant bacteria requires a multifaceted approach and the integration of various strategies [8].

3.1. Standard Hand Hygiene

Hand hygiene is the most important measure to prevent the transmission of multidrug-resistant bacteria. Healthcare workers should adhere to WHO's 5 moments for hand hygiene: before touching a patient, before aseptic procedures, after body fluid exposure risk, after touching a patient, and after touching patient surroundings [9]. Studies show that alcohol-based hand rubs are more effective than soap and water in removing bacteria [10].

3.2. Appropriate Use of Personal Protective Equipment (PPE)

The use of gloves and gowns when in contact with patients or the patient environment is necessary to prevent the spread of bacteria. Proper removal of PPE before leaving the patient's room is also crucial [11].

3.3. Environmental Hygiene and Device Disinfection

Surfaces and medical equipment in the ICU can be contaminated with multidrug-resistant bacteria and act as a source of transmission. Frequently touched surfaces such as bed rails, bedside tables, monitoring equipment, ventilators, and stethoscopes need to be regularly cleaned and disinfected. New technologies such as UV-C and hydrogen peroxide vapor also show potential in environmental disinfection [12, 13].

3.4. Antimicrobial Stewardship (AMS)

Antimicrobial stewardship programs aim to optimize antibiotic use, ensuring the correct choice of antibiotic, dosage, route of administration, and duration of treatment. This helps reduce selective pressure on bacteria, limiting the development and spread of resistant strains [14, 15].

3.5. Surveillance and Monitoring

Continuous surveillance of multidrug-resistant bacterial strains and resistance trends is necessary to detect emerging pathogens early, monitor epidemiological trends, and evaluate the effectiveness of interventions [16]. Methods such as clinical specimen cultures, active surveillance cultures (ASC), and molecular biological techniques can be used [17].

3.6. Continuous Education and Training

Ongoing training and education for healthcare workers on infection control principles, hand hygiene, PPE use, and antimicrobial stewardship are crucial. Training programs need to be regularly updated and emphasize the importance of adhering to procedures [18, 19].

3.7. Isolation and Management of Patients with/Suspected MDR Infection

Contact Precautions should be applied to patients with or suspected of having MDR infection. This includes using private rooms or cohorting and strict adherence to PPE regulations [20].

4. Recommended Actions

4.1. For Healthcare Workers

Strict Hand Hygiene Adherence: Always wash hands with soap and water or an alcohol-based hand rub before and after patient contact, before performing aseptic procedures, after body fluid exposure, and after touching the patient's environment.
Correct PPE Use: Ensure appropriate use of gloves, gowns, masks, and eye protection when necessary, and remove them according to proper procedures.
Device Cleaning and Disinfection: Thoroughly clean and disinfect shared medical equipment and frequently touched surfaces.
Reporting and Surveillance Participation: Promptly report infection cases and participate in surveillance programs to monitor resistance trends.
Knowledge Enhancement: Attend training sessions and stay updated on infection control and multidrug-resistant bacteria.

4.2. For Hospital Leadership

Policy Development and Implementation: Establish and maintain clear, understandable, and implementable infection control policies and procedures.
Resource Investment: Ensure adequate provision of hand hygiene facilities, PPE, disinfectants, and advanced technologies to support prevention efforts.
AMS Program Establishment: Implement and effectively monitor antimicrobial stewardship programs.
Monitoring and Feedback: Establish a system for monitoring compliance with infection control regulations and provide regular feedback to staff.
Physical Environment: Optimize ICU space design, which may include private patient rooms and clearly designated work areas to minimize the risk of cross-contamination [21].

4.3. For Patients and Relatives

Hand Hygiene Cooperation: Patients and relatives should regularly practice hand hygiene, especially before and after patient contact, before eating, and after using the restroom.
Adherence to Guidelines: Follow healthcare staff instructions on infection prevention, including visitor policies and isolation precautions.
Disclosure of Medical History: Provide full information about medical history, especially previous hospitalizations and a history of drug-resistant infections, to assist healthcare staff in assessing risk and implementing appropriate preventive measures.

5. Frequently Asked Questions

What are multidrug-resistant organisms? Multidrug-resistant organisms (MDR) are strains of bacteria that have developed the ability to resist multiple types of antibiotics, making treatment more difficult and complex [22].
Why are ICUs at high risk for multidrug-resistant infections? ICUs are environments with many factors conducive to the development and spread of MDR, including critically ill patients with weakened immune systems, extensive use of invasive devices, and the use of broad-spectrum antibiotics [1, 2].
How can one know if a patient has a multidrug-resistant infection? The diagnosis of multidrug-resistant infections is usually based on the results of cultures from clinical specimens (blood, sputum, urine...) and antibiograms, showing that bacteria are not susceptible to many common antibiotics [22].
What can family members do to prevent it? Family members can help by strictly adhering to hand hygiene rules, limiting unnecessary contact with the patient and surroundings, and following prevention measures set by the hospital [19].
Are antibiotics still effective against multidrug-resistant organisms? For multidrug-resistant organisms, many common antibiotics will no longer be effective. Treatment often requires the use of stronger, less commonly used antibiotics, or combination regimens, and must be based on specific antibiogram results [5].

6. Expert Review & References

Expert Consultation: CN ĐD. Lê Mộng Hảo - Khoa Kiểm soát nhiễm khuẩn, Bệnh Viện Đại Học Y Dược TP. Hồ Chí Minh Date Updated: 2025-11-13

References:

[1] Han, Y., Zhang, J., Zhang, H. Z., Zhang, X. Y., & Wang, Y. M. (2022). Multidrug-resistant organisms in intensive care units and logistic analysis of risk factors. World Journal of Clinical Cases, 10(6), 1795–1805. https://pmc.ncbi.nlm.nih.gov/articles/PMC8891762/. Accessed: 2025-11-13.
[2] AlBahrani, S., Saad, M., Alqahtani, J. S., Almoosa, Z., Alabdulla, M., Algezery, M., AlShehri, S., & Al-Tawfiq, J. A. (2024). Multicomponent Approaches to Reduce Multidrug-Resistant Organisms in Critical Care: Determining the Ideal Strategy. Journal of Epidemiology and Global Health, 14(4), 1371–1380. https://pmc.ncbi.nlm.nih.gov/articles/PMC11652424/. Accessed: 2025-11-13.
[3] Centers for Disease Control and Prevention. (2025). MDRO Prevention Strategies. https://www.cdc.gov/healthcare-associated-infections/php/preventing-mdros/mdro-prevention-strategies.html. Accessed: 2025-11-13.
[4] Fanelli, C., Pistidda, L., Terragni, P., & Pasero, D. (2024). Infection Prevention and Control Strategies According to the Type of Multidrug-Resistant Bacteria and Candida auris in Intensive Care Units: A Pragmatic Resume including Pathogens R0 and a Cost-Effectiveness Analysis. Antibiotics (Basel), 13(8), 789. https://pubmed.ncbi.nlm.nih.gov/39200090/. Accessed: 2025-11-13.
[5] Kang, X., Zhang, P., Xu, Q., Feng, Z., & Yin, B. (2024). Innovative Solutions for Multidrug-Resistant Organisms’ Infections in Intensive Care Unit: A Joint Efficacy Evaluation of Multidisciplinary Team and SHEL (Software, Hardware, Environment, Liveware) Model. Current Therapeutic Research, Clinical and Experimental, 102, 100766. https://pmc.ncbi.nlm.nih.gov/articles/PMC11731589/. Accessed: 2025-11-13.
[6] Geng, Y., Liu, Z., Ma, X., Pan, T., Chen, M., Dang, J., Zhang, P., Chen, C., Zhao, Y., Pan, D., & Liang, P. (2025). Infection prevention and control measures for multidrug-resistant organisms: a systematic review and network meta-analysis. Infection, 53(5), 1789–1800. https://pmc.ncbi.nlm.nih.gov/articles/PMC12460372/. Accessed: 2025-11-13.
[7] Schinas, G., Polyzou, E., Spernovasilis, N., Gogos, C., Dimopoulos, G., & Akinosoglou, K. (2023). Preventing Multidrug-Resistant Bacterial Transmission in the Intensive Care Unit with a Comprehensive Approach: A Policymaking Manual. Antibiotics (Basel), 12(8), 1255. https://pmc.ncbi.nlm.nih.gov/articles/PMC10451180/. Accessed: 2025-11-13.
[8] Centers for Disease Control and Prevention. (2006). MDRO Prevention and Control. https://www.cdc.gov/infection-control/hcp/mdro-management/prevention-control.html. Accessed: 2025-11-13.
[9] Chou, D. T., Achan, P., & Ramachandran, M. (2012). The World Health Organization ‘5 moments of hand hygiene’: The scientific foundation. The Journal of Bone and Joint Surgery. British Volume, 94(4), 441–445. https://pmc.ncbi.nlm.nih.gov/articles/PMC10015275/. Accessed: 2025-11-13.
[10] Widmer, A. F. (2000). Replace hand washing with the use of a waterless alcohol hand rub? Clinical Infectious Diseases, 31(1), 136–143. https://pmc.ncbi.nlm.nih.gov/articles/PMC11652424/. Accessed: 2025-11-13.
[11] Wright, M. O., Hebden, J. N., Harris, A. D., & et al. (2004). Aggressive control measures for resistant acinetobacter baumannii and the impact on acquisition of methicillin-resistantstaphylococcus Aureus and Vancomycin-resistant Enterococcus in a medical intensive care unit. Infection Control and Hospital Epidemiology, 25(2), 167–172. https://pmc.ncbi.nlm.nih.gov/articles/PMC11652424/. Accessed: 2025-11-13.
[12] Otter, J. A., Yezli, S., Perl, T. M., Barbut, F., & French, G. L. (2013). The role of ‘no-touch’ automated room disinfection systems in infection prevention and control. Journal of Hospital Infection, 83(1), 1–13. https://pmc.ncbi.nlm.nih.gov/articles/PMC10451180/. Accessed: 2025-11-13.
[13] Birkett, M., Dover, L., Cherian Lukose, C., Wasy Zia, A., Tambuwala, M. M., & Serrano-Aroca, Á. (2022). Recent Advances in Metal-Based Antimicrobial Coatings for High-Touch Surfaces. International Journal of Molecular Sciences, 23(3), 1162. https://pmc.ncbi.nlm.nih.gov/articles/PMC10451180/. Accessed: 2025-11-13.
[14] Dyar, O. J., Huttner, B., Schouten, J., & Pulcini, C. (2017). What is antimicrobial stewardship? Clinical Microbiology and Infection, 23(11), 793–798. https://pmc.ncbi.nlm.nih.gov/articles/PMC10451180/. Accessed: 2025-11-13.
[15] Spernovasilis, N., Ierodiakonou, D., Spanias, C., Mathioudaki, A., Ioannou, P., Petrakis, E. C., & Kofteridis, D. P. (2021). Doctors’ Perceptions, Attitudes and Practices towards the Management of Multidrug-Resistant Organism Infections after the Implementation of an Antimicrobial Stewardship Programme during the COVID-19 Pandemic. Tropical Medicine and Infectious Disease, 6(1), 20. https://pmc.ncbi.nlm.nih.gov/articles/PMC10451180/. Accessed: 2025-11-13.
[16] Majumder, A. A., Rahman, S., Cohall, D., Bharatha, A., Singh, K., Haque, M., & Hilaire, M. G.-S. (2020). Antimicrobial Stewardship: Fighting Antimicrobial Resistance and Protecting Global Public Health. Infection and Drug Resistance, 13, 4713–4738. https://pmc.ncbi.nlm.nih.gov/articles/PMC10451180/. Accessed: 2025-11-13.
[17] Centers for Disease Control and Prevention. (2006). MDRO Prevention and Control. https://www.cdc.gov/infection-control/hcp/mdro-management/prevention-control.html#overview. Accessed: 2025-11-13.
[18] Haque, M., McKimm, J., Sartelli, M., Dhingra, S., Labricciosa, F. M., Islam, S., Jahan, D., Nusrat, T., Chowdhury, T. S., Coccolini, F., & et al. (2020). Strategies to Prevent Healthcare-Associated Infections: A Narrative Overview. Risk Management and Healthcare Policy, 13, 1765–1780. https://pmc.ncbi.nlm.nih.gov/articles/PMC10451180/. Accessed: 2025-11-13.
[19] Geng, Y., Liu, Z., Ma, X., Pan, T., Chen, M., Dang, J., Zhang, P., Chen, C., Zhao, Y., Pan, D., & Liang, P. (2025). Infection prevention and control measures for multidrug-resistant organisms: a systematic review and network meta-analysis. Infection, 53(5), 1789–1800. https://pmc.ncbi.nlm.nih.gov/articles/PMC12460372/. Accessed: 2025-11-13.
[20] Siegel, J. D., Rhinehart, E., Jackson, M., & Chiarello, L. (2007). 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. American Journal of Infection Control, 35(10 Suppl 2), S65–S164. https://pmc.ncbi.nlm.nih.gov/articles/PMC12460372/. Accessed: 2025-11-13.
[21] Bertuzzi, A., Martin, A., Clarke, N., & et al. (2023). Clinical, humanistic and economic outcomes, including experiencing of patient safety events, associated with admitting patients to single rooms compared with shared accommodation for acute hospital admissions: a systematic review and narrative synthesis. BMJ Open, 13(5), e068932. https://pmc.ncbi.nlm.nih.gov/articles/PMC11731589/. Accessed: 2025-11-13.
[22] Magiorakos, A. P., Srinivasan, A., Carey, R. B., & et al. (2012). Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clinical Microbiology and Infection, 18(3), 268–281. https://pmc.ncbi.nlm.nih.gov/articles/PMC12460372/. Accessed: 2025-11-13.

The information above is for reference purposes only and is not intended as a recommendation. Please consult a doctor for detailed advice.