Pathogen-Specific Hygiene Measures

Hygiene management in case of multidrug-resistant Gram-negative (MRGN) pathogens


How are MDRGN bacteria defined?

MDRGN bacteria are an increasing problem in health care due to limited treatment options in the event of an infection. The definition and classification is based on the phenotypic resistance characteristics of the respective pathogens, regardless of the resistance mechanism. The four important antibiotic groups of cephalosporins, acylureidopenicillins, fluoroquinolones, and carbapenems are used for classification. 3MDRGN pathogens are resistant to three out of four, 4MDRGN pathogens to all four of these antibiotic groups.

Which pathogens belong to MDRGN?

The pathogens in question belong to the enterobacteria or non-fermenters; important representatives are Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumaii. An important reservoir of the pathogens is the gastrointestinal tract. MDRGN colonisation usually affects the patient’s intestinal flora. Possible infections with MDRGN range from wound infections, urinary tract infections, pneumonias to bloodstream infections.

What hygiene measures are necessary?

Hygiene measures for MDRGN bacteria aim to prevent transmission to other patients as well as infection of the MDRGN pathogen carrier. The KRINKO recommendation on hygiene measures in the event of infections or colonisation with multidrug-resistant Gram-negative pathogens provide detailed preventive measures. For this purpose, pathogens and resistance profiles as well as area-specific risks of the facility are considered in a risk analysis. The resulting measures are differentiated between basic hygiene and extended hygiene measures.

Basic hygiene

When 3MDRGN occur in normal wards, compliance with basic hygiene is usually sufficient. Furthermore, consistent application of basic hygiene is a prerequisite for the effectiveness of all other hygiene measures. This includes hand hygiene appropriate to the indication as well as surface and instrument disinfection. The use of personal protective equipment such as gloves or disposable gowns prevents further spread during care activities where there is a risk of contamination of clothing.

Extended hygiene measures

Additional hygiene measures are recommended in risk areas such as intensive care units or when 4MDRGN bacteria occur. Here, the affected persons should be isolated to prevent transmission to other patients. Meaningful concepts for the decolonisation of MDRGN carriers have not yet been established.

Who belongs to the risk group of 4MDRGN?

KRINKO recommends screening for 4MDRGN for patients from one of the following risk groups:

  • People with a known history of 4MDRGN
  • People who have been housed together with a 4MDRGN carrier
  • Patients who have been treated in a hospital in a region with high 4MDRGN prevalence
  • People who were treated in an intensive care unit for more than 7 days in the past year


1 KRINKO (2012) Hygienemaßnahmen bei Infektionen oder Besiedlung mit multiresistenten gramnegativen Stäbchen. Bundesgesundheitsbl 55:1311–1354.

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