Form 0920-1070 ARP SHARP Guidance 2021 P1 Activity B1 MDRO Prevention P

ARP SHARP Guidance 2021 P1 Activity B1 MDRO Prevention Plan Needs
Assessment
Introduction
Historically, efforts to prevent the spread of novel and targeted multidrug-resistant organism (MDROs) have been
response-based and triggered by MDRO detection within individual healthcare facilities (i.e., “containment”). The
addition of a proactive, preventative approach to MDRO detection and infection control improvements, based on
healthcare facility risk factors rather than detection of a case, and strategically coordinated across multiple healthcare
facilities, is predicted to limit spread more effectively and efficiently. Prompt, successful implementation of these
prevention strategies is crucial, as the COVID-19 pandemic has the potential to accelerate the spread of MDROs in the
United States through its unprecedented strain on healthcare system resources. Indeed, multiple reports of MDRO
outbreaks in COVID-19 observation and treatment units in the U.S. and elsewhere have been published. Thus, an urgent
need exists for expanded public health efforts to mitigate the pandemic’s effect on MDRO spread by improved infection
prevention and control and enhanced MDRO detection.
CDC’s “Interim Guidance for Public Health Measures to Prevent the Spread of Novel and Targeted Multidrug-Resistant
Organisms” is in development and expected to be published in 2022; it will provide guidance for developing and
implementing a MDRO Prevention Plan. A MDRO Prevention Plan for both novel and targeted organisms is a proactive
and comprehensive approach, coordinated by public health, to prevent the spread of these organisms among a group of
healthcare facilities. These activities complement, but do not duplicate or replace, MDRO “Containment” response
activities. A fully developed MDRO Prevention Plan should comprise activities from four prevention strategies:
education, improve infection prevention and control practices, detect colonized individuals, and communication. The
specific prevention activities selected should be tailored to different healthcare facility types and guided by an area’s
evolving MDRO epidemiology to have the greatest impact for a jurisdiction.
Purpose
This Needs Assessment is a tool to support jurisdictions receiving Epidemiology and Laboratory Capacity program (ELC)
funding in their assessment of current capacity and future needs to develop and implement an MDRO Prevention Plan. It
will provide feedback to CDC on areas where more support may be required for successful MDRO Prevention Plan
implementation. Last, it should be used during the development of the required ELC MDRO Prevention Workplan (P1
Activity B2), which will highlight the jurisdiction’s MDRO Prevention Plan within the scope of expected work as dictated
by the Strengthening HAI/AR Program (SHARP) guidance.

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Abbreviations

ACH

Acute Care Hospital

APIC

Association of Professionals in Infection Control

AR

Antimicrobial Resistance

ARIE

Antimicrobial Resistance Information Exchange

ARLN

Antimicrobial Resistance Laboratory Network

C auris

Candida auris

CIC

Certification in Infection Control

CP

Contact Precautions

CPOs

Carbapenemase-producing organisms

CRAB

Carbapenem-Resistant Acinetobacter Baumannii

CRE

Carbapenem-Resistant Enterobacterales

CRPA

Carbapenem-Resistant Pseudomonas Aeruginosa

ELC

Epidemiology and Laboratory Capacity program

EVS

Environmental Services

HAI

Healthcare Associated Infections

HAN

Health Alert Network

HCP

Healthcare Personnel

HH

Hand Hygiene

IMP

Imipenemase

IPC

Infection Prevention and Control

KPC

Klebsiella pneumoniae carbapenemase

LTACH

Long-Term Acute Care Hospital

MD

Medical Doctor

MDRO

Multidrug-Resistant Organism

NDM

New Delhi Metallo-β-Lactamase

OXA

Oxacilliinase

PH

Public Health

PPE

Personal Protective Equipment

PPS

Point Prevalence Survey
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RN

Registered Nurse

SNF

Skilled Nursing Facility (not providing ventilator care)

VIM

Verona Integron-encoded Metallo- β-Lactamase

vSNF

ventilator-capable Skilled Nursing Facility

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Instructions: Thank you for completing this Needs Assessment. The tool consists of questions about key MDRO
prevention planning strategy areas and should be answered by members of the jurisdiction’s HAI/AR program in
consultation with other partners such as laboratory staff, if needed. If you have questions about this tool, please contact
HAIAR@cdc.gov.

ELC Jurisdiction
Respondent 1 Name
Respondent 1 Title/ Role in HAI/AR
program
Time in this role (# months and years)
Respondent 2 Name
Respondent 2 Title/Role in HAI/AR
program
Time in this role (# months and years)
Date

General
Questions

Q
ID

Question

Response Options
* - responses with asterisk will follow with
“Please explain” prompt if selected

The following questions will gather general information specific to your jurisdiction’s HAI/AR program.

Jurisdictional
Overview

Jurisdictional
Overview

O1

Does your jurisdiction currently have a complete,
current inventory of non-outpatient healthcare
facilities within the jurisdiction?

- Yes (answer O1.i)
- No * (skip to O2)
- Don’t Know (skip to O2)

O1.i

If yes, does your jurisdiction have sufficient
information to appropriately identify all nonoutpatient healthcare facilities by type (e.g., ACH,
LTACH, SNF, vSNF) to prioritize for MDRO
Prevention Activities?

- Yes
- No *

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Using best available information, how many
facilities in your region are vSNFs or LTACHs, or care
for a similar patient/resident population of high
acuity with long lengths of stay, and are therefore
at high risk of MDRO transmission?
Jurisdictional
Overview

Jurisdictional
Overview

O2

O3

Healthcare facilities at high risk for MDRO transmission
are those facilities that have characteristics associated
with increased risk of importation and transmission of
MDROs (e.g., high-acuity patients, long length of stay).
These generally are long-term acute-care hospitals or
ventilator-capable skilled nursing facilities but may also
include other facility types.

For what proportion of facilities at higher risk for
MDRO transmission (e.g., vSNFs and LTACHs), does
the jurisdiction currently understand the patient
transfer networks?
Transfer networks refers to the facilities that higher
risk facilities most frequently receive patients from
and transfer to.

-

Open Ended
Don’t Know

a) All high-risk facilities
b) More than half of high-risk facilities
c) Half of the high-risk facilities
d) Less than half of high-risk facilities
e) Not available for any high-risk
facilities
f) No high-risk facilities in the
jurisdiction
g) Don’t Know
(i) ACH, (ii) LTACH, (iii) vSNF, (iv) SNF
a)
b)
c)
d)
e)

Jurisdictional
Overview

O4

Please describe the current general relationships
the HAI/AR program has with the following facility
types for MDRO response activities:

Most facilities are collaborative
Some facilities are collaborative
Few facilities are collaborative
Don’t know
N/A - we do not have these
facilities in our jurisdiction

- (O3.i) Please use this space to share
any additional information about the
HAI/AR program and its working
relationships with different healthcare
facilities that you believe to be relevant
to this needs assessment.
- Open ended

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MDRO
Prevention
Q ID
Strategy Area
Education

Education

Response Options
Question

* - responses with asterisk will follow with “Please explain”
prompt if selected

A key strategy of MDRO Prevention planning is to enhance education about MDROs to healthcare
facilities, healthcare personnel (HCP), and other partners. This section aims to identify current
HAI/AR program educational activities and opportunities related to both novel and targeted
MDROs and to determine capacity for future educational activities or strategies.

E1

In the last 3 years (2019-2021), has
the HAI/AR program conducted
virtual MDRO educational trainings
(such as webinars) for healthcare
personnel (HCP)?

-Yes (answer E1.i)
-No*
-Don’t Know
(E1.i) If Y, please indicate approximate number of
virtual trainings (Optional)
(E1.ii) If Y, please briefly describe training
activities. (Optional)

Education

Education

E2

E3

Is the HAI/AR program currently
able to conduct virtual MDRO
educational trainings (such as
webinars) for HCP?

Please indicate any challenges or
limitations the HAI/AR program
currently experiences related to
conducting virtual educational
trainings (such as webinars) for HCP.
(select all that apply)

-Yes, with support from partners (answer E2.i)
-Yes, without support from partners (answer E2.i)
-No
-Don’t Know
(E2.i) If Y, does the HAI/AR program have the
capacity to continue conducting virtual trainings
for HCP in the future? (Yes/No)
Checkboxes:
a) None
b) Insufficient time to organize
c) Insufficient time to implement
d) Insufficient staff with expertise to conduct
the training
e) Insufficient funds
f) Insufficient IT support (e.g., IT platform
needed to hold large audiences)
g) Insufficient training materials
h) Insufficient facility internet connectivity
i) Low attendance due to competing facility
priorities
j) Insufficient HAI/AR program time due to
other competing priorities
k) Other (please specify):
l) Don’t Know

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MDRO
Prevention
Q ID
Strategy Area

Education

E4

Response Options
Question
In the last 3 years (2019-2021), has
the HAI/AR program conducted onsite, educational trainings (formal or
informal) about MDROs for HCP at
healthcare facilities with high-risk
for MDRO transmission (e.g.,
ventilator capable skilled nursing
facilities (vSNFs)/long-term acute
care hospitals (LTACHS))?

* - responses with asterisk will follow with “Please explain”
prompt if selected

-Yes
-No *
-Don’t Know

Onsite trainings for HCP – typically
conducted at single HCP solely for that
facility’s staff and tailored to MDROs
and infrastructure/challenges in that
facility

Education

Education

E5

E6

Is the HAI/AR program currently
able to conduct on-site, educational
trainings (formal or informal) about
MDROs for HCP at healthcare
facilities with high-risk for MDRO
transmission (e.g., vSNFs/LTACHs)?

Please indicate any challenges or
limitations the HAI/AR program
currently experiences related to
conducting on-site, educational HCP
trainings at healthcare facilities
with high-risk for MDRO
transmission (e.g., vSNFs/LTACHs)?
(select all that apply)

-Yes, with support from partners (answer E5.i)
-Yes, w/o support from partners (answer E5.i)
-No
-Don’t Know
(E5.i) If Y, does the HAI/AR program have the
capacity to continue conducting HCP trainings onsite at healthcare facilities with high-risk for
MDRO transmission (e.g., vSNFs/LTACHs) in the
future? (Yes/No)
Checkboxes:
a) None
b) COVID-19 gathering restrictions
c) Insufficient time to organize
d) Insufficient time to implement
e) Insufficient staff with expertise to conduct
the training
f) Insufficient funds (e.g., for travel)
g) Insufficient training materials
h) Low attendance due to competing facility
priorities
i) Insufficient HAI/AR program time due to
other competing priorities
j) Other (please specify):
k) Don’t Know

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MDRO
Prevention
Q ID
Strategy Area

Education

E7

Response Options
Question
In the last 3 years (2019-2021), has
the HAI/AR program conducted inperson MDRO educational trainings
such as workshops or conferences
for HCPs?
Workshops or conferences – typically
attended by multiple healthcare
facilities –and focused on general MDRO
and IPC information

Education

Education

E8

E9

Is the HAI/AR program currently
able to conduct in-person MDRO
educational trainings such as
workshops or conferences for
HCPs?

Please indicate any challenges or
limitations the HAI/AR program
currently experiences related to
conducting in-person educational
trainings such as workshops or
conferences for HCPs?
(select all that apply)

Education

E10

In the last 3 years (2019-2021), has
the HAI/AR program conducted inperson and/or virtual MDRO
educational trainings for nonHCP/HCF audiences, such as state
healthcare facility survey agencies
and licensing boards?

* - responses with asterisk will follow with “Please explain”
prompt if selected

-Yes
-No *
-Don’t Know

-Yes, with support from partners (answer E8.i)
-Yes, w/o support from partners (answer E8.i)
-No
-Don’t Know
(E8.i) If Y, does the HAI/AR program have the
capacity to continue conducting in-person
educational trainings, such as workshops or
conferences, for HCP in the future? (Yes/No)
Checkboxes:
a) None
b) COVID-19 gathering restrictions
c) Insufficient time to organize
d) Insufficient time to implement
e) Insufficient staff with expertise to conduct
the training
f) Insufficient funds (e.g., for travel)
g) Insufficient training materials
h) Low attendance due to competing facility
priorities
i) Insufficient HAI/AR program time due to
other competing priorities Other (please
specify):
j) Don’t Know

-Yes
-No *
-Don’t Know

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MDRO
Prevention
Q ID
Strategy Area

Education

Education

E11

E12

Response Options
Question

* - responses with asterisk will follow with “Please explain”
prompt if selected

Is the HAI/AR program currently
able to conduct in-person and/or
virtual MDRO educational trainings
for non-HCP/HCF audiences such as
healthcare facility survey agencies
and licensing boards?

-Yes, with support from partners (answer E11.i)
-Yes, w/o support from partners (answer E11.i)
-No
-Don’t Know

Please indicate any challenges or
limitations the HAI/AR program
currently experiences related to
conducting in-person and/or virtual
educational trainings for nonHCP/HCF audiences such as
healthcare facility survey agencies
and licensing boards?
(select all that apply)

i.

Education

E13.i &
E13.ii
ii.

Does the HAI/AR program
need additional staff
trainings or educational
materials to expand the
program’s capacity to offer
MDRO education to HCF and
other partners?
Are training materials for
HCP and facilities needed
that would improve capacity
to offer facility MDRO
education?

Checkboxes:
a) None
b) COVID-19 gathering restrictions
c) Insufficient time to organize
d) Insufficient time to implement
e) Insufficient staff with expertise to conduct
the training
f) Insufficient funds
g) Insufficient training materials
h) Insufficient facility internet connectivity
i) Low attendance due to competing priorities
for targeted audience
j) Insufficient HAI/AR program time due to
other competing priorities
k) Other (please specify):
l) Don’t Know

- Yes (answer E14.i)
- No (skip to E15)
- Don’t Know (skip to E15)

- Yes (answer E14.ii)
- No (skip to E15)
- Don’t Know (skip to E15)

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MDRO
Prevention
Q ID
Strategy Area

Response Options
Question

* - responses with asterisk will follow with “Please explain”
prompt if selected

i.

Education

E14.i &
E14.ii

Please describe the additional
training or educational
materials that would be
helpful for HAI/AR program
staff or “train the trainer”
purposes
ii. Please describe the additional
training or educational
materials that would be
helpful for HCP or HCF
audiences
(select all that apply)

Education

E15

Which types of audiences does the
HAI/AR program target with training
materials?
(select all that apply)

Education

E16

Which types of HCP does the HAI/AR
program target with training
materials?
(select all that apply)

Education

E17

Are there audiences the HAI/AR
program would like to reach, but is
not currently able?

Check boxes:
a) Regulatory agencies
b) Other Health Departments
c) Acute Care Hospitals
d) Long Term Care Facilities
e) Other (please specify):
f) Don’t Know
Check boxes:
a) Nurses
b) Nursing aides
c) Physicians
d) Mid-level clinicians (e.g., Physician
Assistants)
e) Environmental Services personnel
f) Non-clinical personnel (e.g., Administrators)
g) Infection Preventionists
h) Ancillary staff (e.g., Respiratory Therapy,
Physical Therapy, etc.)
i) Other (please specify):
j) Don’t Know
-Yes (answer E17i)
-No
-Don’t Know
(E17.i) If yes, which audiences and what is the
gap? What educational materials would be
helpful?

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MDRO
Prevention
Q ID
Strategy Area

Education

Education

Education

E18

E19

E20

Response Options
Question

Does the HAI/AR program currently
use any educational materials in
languages other than English? If so,
which languages?

Does the HAI/AR program currently
need educational materials in
languages other than English, but
not have the ability to develop
them?
Please use this space to share any
additional information about MDRO
education for HCPs, healthcare
facilities and partners, including
areas where additional support is
needed.

* - responses with asterisk will follow with “Please explain”
prompt if selected

-Yes (answer E18.i)
-No
-Don’t Know
(E18.i) If Y, please indicate which languages
(checkboxes - select all that apply)
- Yes (answer E19.i)
- No
- Don’t Know
(E19.i) If Y, please indicate which languages
(checkboxes - select all that apply):

- Open-ended

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MDRO
Prevention
Q ID
Strategy Area
Infection
Prevention and
Control

Infection
Prevention and
Control

Question

IPC1

Please indicate which staff within
the HAI/AR program conduct MDRO
targeted IPC assessments (virtual or
onsite).

IPC2

What is the highest level of IPC
training held by staff within the
HAI/AR program who conduct
MDRO targeted IPC assessments?
(select all that apply)

Infection
Prevention and
Control

Infection
Prevention and
Control

Infection
Prevention and
Control

* - responses with asterisk will follow with “Please explain”
prompt if selected

Another key strategy is to improve infection prevention and control (IPC) within healthcare
facilities. This section aims to identify the IPC technical support practices within the HAI/AR
program as well as any challenges or limitations experienced in their implementation.

(select all that apply)

Infection
Prevention and
Control

Response Options

IPC3

Are other partners, contract
agencies or regulatory bodies
involved in MDRO targeted IPC
assessments (virtual or onsite)?

Checkboxes:
a) HAI/AR program coordinator/manager
b) Public Health Nurse
c) Staff Infection Preventionist
d) HAI/AR Epidemiologist
e) Other (please specify):
f) Don’t Know
Checkboxes:
a) Clinical degree (e.g., RN, MD)
b) Certification in Infection Control (CIC)
c) On-the-job training
d) Other (please specify):
e) Don’t Know
- Yes (answer IPC3.i)
- No
- Don’t Know
(IPC3.i) If Y, please specify:

IPC4

In the last 3 years (2019-2021), has
the HAI/AR program ever conducted
IPC assessments for MDROs (for
either response or prevention
purposes) at:
i. Acute Care Hospitals (ACH)
ii. Long-term Acute Care Hospitals
(LTACH)
iii. Ventilator-capable Skilled
Nursing Facilities (vSNF)
iv. Skilled Nursing Facilities not
providing ventilator care (SNF)

- Yes, onsite but not virtually
- Yes, virtually but not onsite
- Yes, both onsite and virtually
- No *
- Don’t Know

IPC5

Does the HAI/AR program currently
use a database (or other electronic
tracking system) to document which
facilities have had an MDRO
targeted IPC assessment?

- Yes
- No *
- Don’t Know

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MDRO
Prevention
Q ID
Strategy Area

Question

Infection
Prevention and
Control

IPC6

Does the HAI/AR program provide
the facility with written
recommendations following an IPC
assessment?

- Yes (answer IPC6.i)
- No * (skip to IPC7)
- Don’t Know (skip to IPC7)

IPC6.i

If yes, does the HAI/AR program
track implementation of
recommendations by the facility?

- Yes
- No
- Don’t Know

IPC7

How often does the HAI/AR program
typically (in the last 3 years, 20192021) perform on-site IPC
assessments (full or MDRO-targeted
ICAR) in response to MDRO case
identification as recommended by
CDC’s Interim Guidance for a Public
Health Response to Contain Novel or
Targeted MDROs?
i. ACH
ii. LTACH
iii. vSNF
iv. SNF

Infection
Prevention and
Control

Infection
Prevention and
Control

Response Options
* - responses with asterisk will follow with “Please explain”
prompt if selected

a)
b)
c)
d)
e)
f)

Always
Most of the time
Some of the time
Rarely
Never
N/A – Jurisdiction has not had novel or
targeted MDRO in this setting in last 3 years
g) Don’t Know

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MDRO
Prevention
Q ID
Strategy Area

Question

Infection
Prevention and
Control

Checkboxes:
a) None
b) COIVID-19 restrictions for on-site work
c) Insufficient HAI/AR program staff time to
Please indicate any challenges or
coordinate (e.g., schedule)
limitations the HAI/AR program
d)
Insufficient HAI/AR program staff time to
currently experiences related to
conduct
routinely performing on-site,
e)
Insufficient staff with expertise to conduct the
MDRO-targeted IPC assessments in
assessments
response to single MDRO case
f) External support needed to conduct the
identification as recommended by
assessments (e.g., academic partners, outside
CDC’s Interim Guidance for a Public
consultants such as APIC, etc.)
Health Response to Contain Novel or
g)
Insufficient travel funds
Targeted MDROs?
h)
Insufficient assessment materials
i. Acute Care Hospitals (ACH)
ii. Long-term Acute Care Hospitals i) Facility non-responsiveness/Unable to reach
facilities by phone/email to schedule visit
(LTACH)
j) Competing priorities for facilities limit
iii. Ventilator-capable Skilled
Nursing Facilities (vSNF)
participation
iv. Skilled Nursing Facilities not
k) Difficult to reach facilities due to distance or
providing ventilator care (SNF)
hard-to-reach location
l) Competing HAI/AR program time priorities
(select all that apply)
m) N/A – we have not performed assessment in
this facility type
n) N/A – we do not have this facility type in our
jurisdiction
o) Other (please specify):
p) Don’t Know

Infection
Prevention and
Control

IPC8

Does the HAI/AR program currently
have the capacity to systematically
select facilities at high risk for MDRO
transmission for proactive (i.e.,
regardless of MDRO case
identification), on-site MDROtargeted IPC assessments?
IPC9
Higher risk facilities defined as certain
health care facilities, such as long-term
acute-care hospitals or ventilatorcapable skilled nursing facilities, which
have characteristics that are associated
with increased risk of importation and
transmission of MDROs (e.g., highacuity patients, long length of stay).

Response Options
* - responses with asterisk will follow with “Please explain”
prompt if selected

- Yes
- No
- Don’t know
- N/A – there are no high-risk facilities in our
jurisdiction

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MDRO
Prevention
Q ID
Strategy Area

Question

Infection
Prevention and
Control

Among facilities at high risk for
MDRO transmission (e.g., vSNFs
and LTACHs) in the jurisdiction, at
what proportion is the HAI/AR
program be able to conduct
proactive, on-site MDRO IPC
assessments at least annually?

Infection
Prevention and
Control

IPC10

IPC11

Please indicate any challenges or
limitations the HAI/AR program
currently has or anticipates having
with performing proactive, on-site
MDRO-targeted IPC assessments at
facilities at high risk for MDRO
transmission (e.g., vSNFs and
LTACHs) in the jurisdiction?
(select all that apply)

Response Options
* - responses with asterisk will follow with “Please explain”
prompt if selected

a) All facilities
b) More than half of facilities
c) Half of the facilities
d) Less than half of facilities
e) None of the facilities
f) N/A– there are no high-risk facilities in our
jurisdiction
g) Don’t Know
Checkboxes:
a) None
b) COIVID-19 restrictions for on-site work
c) Insufficient HAI/AR program staff time to
coordinate (e.g., schedule)
d) Insufficient HAI/AR program staff time to
conduct
e) Insufficient staff with expertise to conduct the
assessments
f) External support needed to conduct the
assessments (e.g., academic partners, outside
consultants such as APIC, etc.)
g) Insufficient travel funds
h) Insufficient assessment materials
i) Facility non-responsiveness/Unable to reach
facilities by phone/email to schedule visit
j) Competing priorities for facilities limit
participation
k) Difficult to reach facilities due to distance or
hard-to-reach location
l) Competing HAI/AR program time priorities
m) N/A – we have not performed assessment in
this facility type
n) N/A – we do not have this facility type in our
jurisdiction
o) Other (please specify):
p) Don’t Know

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MDRO
Prevention
Q ID
Strategy Area

Infection
Prevention and
Control

IPC12

Question

Please indicate the frequency by
facility type that the HAI/AR
program currently conducts followup assessments (on-site or virtual)
after critical infection control gaps
are noted on a MDRO-targeted
infection control assessment
(response-based or proactive)
i. ACH
ii. LTACH
iii. vSNF
iv. SNF

Response Options
* - responses with asterisk will follow with “Please explain”
prompt if selected

a)
b)
c)
d)
e)
f)

Always
Most of the time
Some of the time
Rarely
Never
N/A – we have not performed assessment or
have not identified critical gaps in this facility
type
g) Don’t Know

Critical gaps include gaps in knowledge
about MDROs among HCP, gaps in IPC
practices, gaps in communication
practices, etc.

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MDRO
Prevention
Q ID
Strategy Area

Infection
Prevention and
Control

IPC13

Question

Please indicate any challenges or
limitations by facility type that the
HAI/AR program currently
experiences related to providing
infection control follow-up
assessments (on-site or virtual)?
i. Acute Care Hospitals (ACH)
ii. Long-term Acute Care Hospitals
(LTACH)
iii. Ventilator-capable Skilled
Nursing Facilities (vSNF)
iv. Skilled Nursing Facilities not
providing ventilator care (SNF)
(select all that apply)

Infection
Prevention and
Control

IPC14

Is the HAI/AR program currently
able to provide virtual MDROtargeted infection control
assessments with facility
visualization via camera use?

Response Options
* - responses with asterisk will follow with “Please explain”
prompt if selected

Checkboxes:
a) None
b) COVID-19 restrictions for on-site work
c) Insufficient HAI/AR program staff time to
coordinate (e.g., schedule) and/or conduct
d) Additional healthcare facility staff needed to
coordinate and/or conduct
e) Insufficient number of staff with expertise to
conduct the follow-up
f) External support (e.g., academic partners,
outside consultants such as APIC, etc.)
needed to conduct follow-ups (virtually or
onsite)
g) Insufficient funds
h) Lack of reliable web platform required to
conduct virtual assessment
i) Competing priorities for facilities limit
participation
j) Insufficient facility internet connectivity
k) Facility unwilling to allow camera use during
virtual assessment
l) Difficult to reach facilities due to distance or
hard-to-reach location
m) Insufficient HAI/AR program time due to
other competing priorities
n) Restrictions for going onsite
o) N/A – we have not performed assessment in
this facility type
p) N/A – we do not have this facility type in our
jurisdiction
q) Other (please specify):
r) Don’t Know
- Yes
- No
- Don’t Know

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MDRO
Prevention
Q ID
Strategy Area

Infection
Prevention and
Control

IPC15

Question

Please indicate any challenges or
limitations the HAI/AR program
experiences related to providing
virtual MDRO-targeted infection
control assessments via camera
use?
(select all that apply)

Infection
Prevention and
Control

Infection
Prevention and
Control

IPC16

How often does the HAI/AR program
currently recommend nursing
homes implement Enhanced Barrier
Precautions (EBP) as part of MDRO
containment response?

IPC17

Please use this space to share any
additional information including
areas where additional support for
MDRO related IPC practices is
needed?

Response Options
* - responses with asterisk will follow with “Please explain”
prompt if selected

Checkboxes:
a) None
b) Insufficient HAI/AR program staff time to
coordinate (e.g., schedule) and/or conduct
c) Additional healthcare facility staff needed to
coordinate and/or conduct
d) Insufficient number of staff with expertise to
conduct the virtual assessment
e) External support needed to conduct the
virtual assessment
f) Lack of reliable web platform required to
conduct the assessment
g) Competing priorities for facilities limit
participation
h) Insufficient facility internet connectivity
i) Facility unwilling to allow for camera use
j) Insufficient HAI/AR program time due to
other competing priorities
k) Other (please specify):
l) Don’t Know
a)
b)
c)
d)
e)
f)

Always
Most of the time
Some of the time
Rarely
Never
Don’t Know

- Open-ended

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MDRO
Prevention
Q ID
Strategy Area

Communication

Communication

Question

Communication

C1

Please indicate which of the
following mechanisms the HAI/AR
program uses to support healthcare
facility interfacility communication
during patient/resident transfer.

C2

C2.i

Does the HAI/AR program currently
have a mechanism to rapidly
communicate MDRO-related
epidemiological and surveillance
information (e.g., an increase in
NDM-CRE cases or first detection of
Candida auris in a region) to
healthcare facilities?

If yes, how is this usually
conducted?
(select all that apply)

Communication

* - responses with asterisk will follow with “Please explain”
prompt if selected

Another key strategy for MDRO Prevention is improving communication between healthcare
facilities, between healthcare facilities and public health, and between public health jurisdictions.
This section aims to describe current HAI/AR program communication practices.

(select all that apply)

Communication

Response Options

C2.ii

If yes, does the HAI/AR program
currently have a way to ensure
contact lists for healthcare facilities
are maintained?

Checkboxes:
a) None
b) Health department tracks patients with
novel and targeted MDRO and notifies
healthcare facilities at transfer (e.g., phone
call, email)
c) Healthcare facilities are encouraged to use a
standard interfacility communication form
d) Healthcare facilities are mandated to use a
standard interfacility communication form
e) Antibiotic Resistance Information Exchange
(ARIE) (e.g., MDRO registry)
f) Other (please specify):
g) Don’t Know

- Yes (answer C2.i and C2.ii)
- No * (skip to C3)
- Don’t Know (skip to C3)

Checkboxes:
a) Email
b) Phone
c) Text alert
d) Fax
e) Health alert network (HAN) notification
f) Other (please specify)
g) Don’t Know
- Yes
- No *
- Don’t Know

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Communication

Communication

C3

C4

Are there any barriers in
communicating MDRO-related
information to other jurisdictional
health departments (e.g., local
health departments (LHDs), other
state health departments)?
Please use this space to share any
additional information, including
areas where additional support
could facilitate interfacility and
facility-health department
communication?

- Yes (answer C3.i)
- No
- Don’t Know
(C3.i) If Y, please specify.

- Open-ended

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MDRO
Prevention
Q ID
Strategy Area
Detect
Colonized
Individuals

Detect
Colonized
Individuals

Question

Response Options
* - responses with asterisk will follow with “Please explain”
prompt if selected

Another key strategy is to proactively detect colonized individuals.
This section aims to determine current practices and capacity for active colonization surveillance
within the HAI/AR program and to identify any challenges or limitations experienced in
implementation.

DCI1

In the last 3 years (2019-2021), has
the HAI/AR program facilitated any
MDRO colonization screening
(includes PPS, admission, or
discharge screening)?

-Yes (answer DCI2)
-No * (skip to DCI3)
-Don’t Know (skip to DCI3)

DCI1.i - Admission screening – Y/N/DK (then
check which organism and mechanism, where
applicable) – C auris; CPOs with KPC, VIM, IMP,
OXA-48-like, NDM; CRAB with OXA-23,-24/40, 58)
If yes, which of the following
MDRO* colonization screening
strategies has the HAI/AR program
performed/facilitated?
Detect
Colonized
Individuals

DCI2

DCI1.ii - Discharge screening – Y/N/DK (then
check which organism (and mechanism, where
applicable) – C auris; CPOs with KPC, VIM, IMP,
OXA-48-like, NDM; CRAB with OXA-23,-24/40, 58)

*For the purpose of this question
MDROs refer to the targeted MDROs
DCI1.iii - PPS in response to cases at a facility –
C. auris and CPOs.
Y/N/DK (then check which organism – C auris;
CPOs with KPC, VIM, IMP, OXA-48-like, NDM;
(CPOs include carbapenemase
CRAB with OXA-23,-24/40, -58)
producing CRE, CRPA, and CRAB)

DCI1.iv - PPS at facility without known case
(proactive) – Y/N/DK (then check which bug – C
auris; CPOs with KPC, VIM, IMP, OXA-48-like,
NDM; CRAB with OXA-23,-24/40, -58)

Detect
Colonized
Individuals

DCI3

How often is the HAI/AR program
currently able to conduct
colonization screenings (e.g.,
screening of high-risk contacts,
point prevalence surveys [PPSs]) in
response to a case of a novel or
targeted MDRO as recommended by
CDC’s Interim Guidance for a Public
Health Response to Contain Novel or
Targeted MDROs?

Please answer for i.) short stay facilities (ACH);
and ii.) long stay facilities (e.g., LTACH, SNF,
vSNF):
a) Always
b) Most of the time
c) Some of the time
d) Rarely
e) Never
f) Screening has not been conducted in this
facility type in our jurisdiction
g) Don’t Know

21 | P a g e

MDRO
Prevention
Q ID
Strategy Area

Detect
Colonized
Individuals

DCI4

Question

Please indicate any challenges or
limitations the HAI/AR program
currently experiences related to
conducting colonization screenings
in response to a case of a novel or
targeted MDRO?
(select all that apply)

Detect
Colonized
Individuals

DCI5

During the SHARP funding
timeframe, in what proportion of
high-risk facilities (i.e., vSNFs,
LTACHs) does the HAI/AR program
anticipate instituting at least one
proactive PPSs for targeted MDROs
(e.g., CPOs, C. auris)?
Proactive PPS: PPS performed for
prevention purposes at facility
selected based on risk factors for
MDRO transmission. Differs from
PPS performed in response to new
case of a novel or targeted MDRO.

Detect
Colonized
Individuals

DCI5.i

Please indicate the anticipated
frequency for conducting proactive
PPSs (per targeted facility) in your
jurisdiction.

Response Options
* - responses with asterisk will follow with “Please explain”
prompt if selected

Checkboxes:
a) None
b) Insufficient public health laboratory resources
to screen desired number of contacts
c) Insufficient staff within the HAI/AR program
to coordinate screenings
d) Insufficient staff outside the HAI/AR program
(e.g., local health departments) to coordinate
screenings
e) Insufficient HAI/AR program time due to
other competing priorities
f) Limited experience with screening among
HAI/AR program staff
g) Facilities unwilling to perform screening
h) High refusal rates among patients/residents
i) Challenges with packing and shipping (please
describe)
j) High specimen rejection rates (e.g., due to
improper labeling, leakage)
k) Other (please specify):
l) Don’t Know
a) No targeted PPS possible at this time (skip to
DCI6)
b) All high-risk facilities in jurisdiction (answer
DCI5.i)
c) More than half of high-risk facilities in
jurisdiction (answer DCI5.i)
d) About half of high-risk facilities in jurisdiction
(answer DCI5.i)
e) Less than half of the high-risk facilities in
jurisdiction (answer DCI5.i)
f) Not necessary in this jurisdiction / Not
epidemiologically important in this
jurisdiction (skip to DCI6)
g) N/A-no high-risk facilities in the jurisdiction
(skip to DC16)
h) Don’t Know (skip to DCI6)
a)
b)
c)
d)
e)
f)

Once a year
Twice a year
Quarterly
More frequent than quarterly
Don’t know
Other (please specify):

22 | P a g e

MDRO
Prevention
Q ID
Strategy Area

Detect
Colonized
Individuals

Question
For which organisms do you
anticipate instituting proactive
PPSs?

DCI5.ii
(select all that apply)

Response Options
* - responses with asterisk will follow with “Please explain”
prompt if selected

a)
b)
c)
d)

C auris
CPOs with KPC, VIM, IMP, OXA-48-like, NDM
CRAB with OXA-23, -24/40, -58
Don’t Know

(CPOs include CRE, CRPA, and CRAB)

Detect
Colonized
Individuals

DCI6

Please indicate any challenges or
limitations you anticipate the
HAI/AR program experiencing
related to proactive PPSs?
(select all that apply)

Checkboxes
a) None
b) Insufficient public health laboratory
resources to implement screening at desired
number of facilities (DCI6.b.i) Please explain
further
c) Insufficient public health laboratory
resources to implement screening at desired
frequency (DCI5.i) Please describe target
frequency
d) Challenges with coordinating logistics (e.g.,
coordinating with facilities and regional labs
and PH staff onsite)
e) Insufficient staff within the HAI/AR program
to coordinate PPSs
f) Current HAI/AR program staff lack
experience to implement proactive PPS
colonization screening
g) Insufficient staff outside of the HAI/AR
programs (e.g., local health departments) to
coordinate PPSs
h) Insufficient HAI/AR program time due to
other competing priorities
i) Facilities unwilling to participate
j) Too logistically complicated for facilities to
initiate or maintain
k) “Snowball” effect of PPS identifying hidden
outbreaks and needing to implement
response activities or broaden screening
l) N/A – no PPS planned at this time
m) Other (please specify):
n) Don’t Know

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MDRO
Prevention
Q ID
Strategy Area

Detect
Colonized
Individuals

DCI7

Question

Please indicate any challenges or
limitations the HAI/AR program
currently has or anticipates having
with instituting admissions
screenings?
(select all that apply)

Response Options
* - responses with asterisk will follow with “Please explain”
prompt if selected

Checkboxes:
a) None
b) Insufficient public health laboratory
resources
c) Logistical challenges for public health to
coordinate specimen collection and testing
d) Logistical challenges to communicate results
e) Concerns about impact on patient flow (e.g.,
admission refusals, inadvertent creation of a
test negative requirement from facilities)
f) Insufficient staff within the HAI/AR program
to coordinate screenings
g) Insufficient staff outside the HAI/AR
program (e.g., local health departments) to
coordinate screenings
h) Insufficient time due to other competing
priorities
i) Facilities unwilling
j) Too logistically complicated for facilities to
initiate or maintain
k) N/A – no current or future plans for
admissions screening in the jurisdiction
l) Other (please specify):
m) Don’t Know

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MDRO
Prevention
Q ID
Strategy Area

Detect
Colonized
Individuals

DCI8

Question

Please indicate any challenges or
limitations the HAI/AR program
currently has or anticipates having
with instituting discharge
screening?
(select all that apply)

Detect
Colonized
Individuals

DCI9

Please use this space to share any
additional information including
areas where additional support is
needed for the detection of
colonized individuals.

Response Options
* - responses with asterisk will follow with “Please explain”
prompt if selected

Checkboxes:
a) None
b) Insufficient public health laboratory
resources
c) Logistical challenges for public health to
coordinate specimen collection and testing
d) Logistical challenges to communicate results
e) Concerns about impact on patient flow (e.g.,
admission refusals, inadvertent creation of a
test negative requirement from facilities)
f) Insufficient staff within the HAI/AR program
to coordinate screenings
g) Insufficient staff outside the HAI/AR program
(e.g., local health departments) to coordinate
screenings
h) Insufficient time due to other competing
priorities
i) Facilities unwilling
j) Too logistically complicated for facilities to
initiate or maintain
k) N/A – no current or future plans for discharge
screening in the jurisdiction
l) Other (please specify):
m) Don’t Know

- Open-ended

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MDRO
Prevention
Q ID
Strategy Area

Question

Response Options
* - responses with asterisk will follow with “Please explain”
prompt if selected

Other Areas

General
Surveillance

General
Surveillance

General
Surveillance

This section aims to determine what general surveillance activities are routinely implemented by
the HAI/AR program in relation to both novel and targeted MDROs.

GS1

Does the HAI/AR program currently
maintain an electronic database for
tracking novel and emerging MDROs
within the jurisdiction?
Does the HAI/AR program routinely
collect and record epidemiological
data on most (e.g., over 80%)
reported MDRO cases?

GS2
Examples of epidemiological data
include long term care exposure,
international travel history, patient
risk factors, etc.

- Yes
- No
- Don’t Know

Answer for:
(a) CP-CRAB; (b) KPC-CRE; (c) non-KPC CP-CRE;
(d) CP-CRPA; (e) C auris
- Yes
- No
- Don’t Know

GS3 (ad)

Is the HAI/AR program able to
analyze available MDRO data (e.g.,
state/local surveillance systems
output, testing results from the AR
Laboratory Network, case report
form collection, etc.) to define
jurisdictional epidemiology to guide
MDRO prevention and response
strategies?

Answer for:
a) CP-CRAB; (b) KPC-CRE; (c) non-KPC CP-CRE;
(d) CP-CRPA; (e) C auris
- Yes
- No, program does not have analytic capacity
-No, program does not have data available to
analyze
-N/A, this MDRO has not been identified in
our jurisdiction
- Don’t Know

General
Surveillance

GS6

Please use this space to share any
additional information including
areas where additional support is
needed for general surveillance.

- Open-ended

Clinical
Laboratories
and Clinical
Isolates

This section aims to identify current practices related to both novel and targeted MDROs and
clinical laboratories within the HAI/AR program.

General
Surveillance

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MDRO
Prevention
Q ID
Strategy Area

Question

Clinical
Laboratories
and Clinical
Isolates

CL1

Does the HAI/AR program currently
have an up-to-date inventory of all
clinical laboratories and which
facilities they serve in the
jurisdiction?

- Yes
- No
- Don’t Know

CL2

Does the HAI/AR program currently
have a mechanism to rapidly
communicate epidemiologically
important, MDRO-related
information (i.e., a rise in detection
of isolates producing NDM enzymes)
to clinical laboratories in the
jurisdiction?

- Yes (answer CL2.i)
- No (skip to CL3)
- Don’t Know (skip to CL3)

Clinical
Laboratories
and Clinical
Isolates

Clinical
Laboratories
and Clinical
Isolates

Clinical
Laboratories
and Clinical
Isolates

If yes, how is this usually conducted:
CL2.i
(select all that apply)

CL3

How does the HAI/AR program
assess compliance with reporting
and isolate submission from clinical
laboratories?
(select all that apply)

Clinical
Laboratories
and Clinical
Isolates

CL4

Does the HAI/AR program assess, at
least annually, the capacity for
clinical laboratories serving health
care facilities within the jurisdiction
to identify:
a) CP CRE
b) CP CRPA
c) CP CRAB
d) C auris

Response Options
* - responses with asterisk will follow with “Please explain”
prompt if selected

Checkboxes:
a) Email
b) Phone
c) Text alert
d) Fax
e) LIMS
f) Other (please specify):
g) Don’t Know
a) Audits of reports
b) Audits of isolate submission
c) N/A - no state or local mandate exists for
reporting or isolate submission
d) Compliance not assessed
e) Other (please describe):
f) Don’t Know

- Yes
- No
- Don’t Know

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MDRO
Prevention
Q ID
Strategy Area

Clinical
Laboratories
and Clinical
Isolates

Clinical
Laboratories
and Clinical
Isolates

CL5

CL6

Question

Does the HAI/AR program know
which clinical laboratories serving
facilities in their jurisdiction can
conduct routine colonization
screenings such as admission
screening or point prevalence
surveys?
Please use this space to share any
additional information, including
areas where additional support is
needed to understand clinical
laboratory practices.

Response Options
* - responses with asterisk will follow with “Please explain”
prompt if selected

Answer for:
(a) C auris; (b) CPOs with KPC, VIM, IMP, OXA-48like, NDM; (c) CRAB with OXA-23,-24/40, -58
- Yes
- No
(CPOs include CRE, CRPA, and CRAB)

-

Open-ended

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MDRO
Prevention
Q ID
Strategy Area

Health Equity

Health Equity

Health Equity

Health Equity

Health Equity

Question

Response Options
* - responses with asterisk will follow with “Please explain”
prompt if selected

This section aims to understand what knowledge and/or application of health equity principles and
issues HAI/AR programs might have as they relate to MDRO prevention planning efforts. Health
Equity continues to be an issue of interest at CDC.

HE1

Is your jurisdiction aware of any
ACH, LTACH or LTC facilities that
may be serving marginalized and
minority communities with
compromised access to adequate
healthcare?

HE1.i

If yes, how are these communities
identified at the facility level? What
data sources does the HAI/AR
program use?

HE2

Is the HAI/AR program aware of any
disparities in health outcomes
related to hospital-associated
infections (HAIs) and MDROs within
jurisdictional healthcare facilities?

HE3

Please use this space to share any
additional information, including
areas where additional support or
training might be needed related to
health equity.

- Yes (answer HE1.i)
- No (skip to HE2)
- Don’t know (skip to HE2)

- Open-ended

- Yes (answer HE3.i)
- No
- Don’t know
-(HE3.i) If yes, please specify:

-Open-ended

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