To address the complexity of both minimizing the transmission of VRE, MRSA, and C. difficile in the inpatient psychiatric setting through infection control measures with the needs of the patient's psychiatric treatment plan, the following measures are to be implemented for patients known to be colonized or infected with vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), C. difficile (infection only), and other epidemiologically significant organisms transmitted by direct or indirect contact.

Identification
As part of the intake process, inpatient transfers shall be screened for the presence or absence of VRE, MRSA, C. difficile, and/or other epidemiologically significant organisms through review of the medical record and/or the presence of Contact Precautions in use. The site(s) where the resistant organism is located, the presence or absence of infected bodily secretions/excretions which can or cannot be contained and the patient’s ability to comply with directions are to be noted before transfer. Outpatients admitted directly or via the Crisis Intervention Unit shall be screened using the automated resistant organism file in CCSS which is activated at the time a bed is booked for admission. If a patient is identified as having a history of VRE, MRSA, and/or another epidemiologically significant organism, the same process for determining the specific level of precautions will be used as for inpatient transfers. All questions regarding a patient’s history of VRE, MRSA, etc. should be directed to YNHH Epidemiology & Infection Control at 8-4634. If there is any doubt regarding such history, the patient should be placed on the appropriate level of precautions as delineated below and Hospital Epidemiology should be contacted.