Navigating guidelines for MDR-GNR

There’s a plethora of guidelines for MDR-GNR. But how do we choose between them? And how do we implement them effectively in our hospitals? I did a talk on this recently in London, here:

I’ve also done an update on the update of my comparison of CPE prevention and control guidelines, summarised below:

 

cpe-guidelines-matrix-updated.pngBlue square = recommended; Orange square = not recommended; Blank = not mentioned or no recommendation.*ESCMID guidelines did not include CPE specifically, but did include recommendation for MDR K. pneumoniae, which are included here as a proxy for CPE because the guidelines also included separate recommendations for ESBL-E. 

Key changes from the last version:

  • I’ve distinguished between patient skin and gastrointestinal decolonisation. This has been quite insightful, and has highlighted some more differences in the guidelines. The CDC (2015), ESCMID (2014), and ECDC (2017) CPE guidelines take a fairly favourable view towards skin decontamination using chlorhexidine, especially during outbreaks. However, the PHE (2013), Scottish (2016), Irish (2014), UK working party (2016), and Australian (2017) guidelines recommend against attempting to decolonise / decontaminate the skin, because the gut is the source of colonisation.
  • Most importantly, the colour scheme has changed; it was red/green but it’s been pointed out to me that some people are red/green colour blind. So it’s become a (much more attractive) blue / orange!

Finally, I have a question for you: Reflections is typically a text only (with an image if you’re lucky) blog. But should we get more multimedia (like this post?!):


 

3 thoughts on “Navigating guidelines for MDR-GNR

  1. Dear John Otter.
    Many thanks for posting this very useful guideline mapping.
    In the text it says: “the PHE (2013), Scottish (2016), Irish (2014), UK working party (2016), and Australian (2017) guidelines recommend AGAINST attempting to decolonise / decontaminate the skin, because the gut is the source of colonisation. So I was wondering if the Irish MDRO, UK Working Party and Australia should have orange squares (rather than blank) for “Patient skin decolonization”?
    BW
    Kirsten Gravningen, Norwegian Institute of PH, Norway

    Like

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