Infection prevention and control for multidrug-resistant organisms in adult social care settings
This guidance is for staff and managers working in adult social care settings (ASC). It gives information on multidrug-resistant organisms and principles on how to prevent the spread of these pathogens.
Main messages
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multidrug-resistant organisms (MDROs) are pathogens that do not respond to common treatments such as antibiotics, antivirals, antifungals and antiparasitics, making them difficult to treat
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MDROs spread through direct contact (including care activities) and indirect contact (for example, contaminated surfaces or equipment)
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individuals at higher risk of infection include those with wounds, medical devices, or weakened immunity. Carriage without symptoms is common, not harmful, and can last years
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it is usually safe to admit or readmit someone with current or previous MDRO carriage. Good infection prevention and control (IPC) practices will lower the chance of spread
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main contributors to spread include poor hand hygiene, contaminated environments, and unclean equipment
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it is important to balance safety with dignity, autonomy, and inclusion for individuals carrying MDROs
Summary of recommendations
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clean hands before and after contact with individuals with a MDRO using soap and water or alcohol-based hand rub
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support individuals with a MDRO to clean their hands frequently and remind visitors to clean their hands too
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promote good respiratory hygiene and improve ventilation when respiratory infections are suspected or confirmed
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use personal protective equipment (PPE) such as gloves, aprons, masks, and eye protection if there is a risk of blood or body fluid exposure
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clean the environment daily, focusing on high-touch areas
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disinfect shared equipment before and after use
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clean and dirty linen should be kept separate at all times
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wash infectious linen at high temperatures
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follow standard waste disposal procedures unless advised otherwise
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accommodate individuals with an MDRO in single rooms with ensuite if possible
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let healthcare staff know about MDRO carriage during admission or transfer
Introduction
This guidance explains how to prevent the spread of multidrug-resistant organisms (MDROs) and provides infection prevention and control principles for staff and managers working in adult social care (ASC) settings.
ASC settings include:
- care homes for older adults
- homes for younger adults with learning disabilities
- day centres
- extra care services
- supported living and care provided at home (domiciliary care)
It is a large, diverse and complex sector, with both private and publicly funded providers.
The term ‘individual’ is used throughout this guidance to refer to people who access care and support in any of the ASC settings described above and domiciliary care services.
Staff providing care and support to individuals should follow the IPC principles set out below to minimise the risk of spreading MDROs within a care setting. Staff undertaking environmental cleaning and those who are responsible for giving medications should also follow the relevant advice in this guidance.
What multidrug-resistant organisms are
Multidrug-resistant organisms (MDROs) are pathogens that can cause infections which are difficult to treat because they do not respond to common treatments such as antibiotics, antivirals, antifungals and antiparasitics. With fewer treatment options available, people who have an infection caused by an MDRO might be at risk of severe illness or death.
Some examples of common MDROs in England include:
- meticillin-resistant Staphylococcus aureus (MRSA) - a multidrug-resistant strain of a bacteria that may cause skin infections, pneumonia (chest infections), and blood infections
- vancomycin-resistant Enterococci (VRE) - a multidrug-resistant strain of a bacteria that can live in the gut and may cause infections in wounds, bloodstream and urinary tract
- carbapenemase-producing Enterobacterales (CPE), for example multidrug-resistant strains of common bacteria like Escherichia coli (E. coli) and Klebsiella pneumoniae - these bacteria can cause bloodstream infections, urinary tract infections, and pneumonia
- Candidozyma auris (C. auris) - a type of fungus (yeast) which is resistant to many anti-fungal treatments. It can cause bloodstream, wound and ear infections
People can carry MDROs without any signs or symptoms of infection. The medical terms used to describe this are colonisation or carriage. Colonisation can continue for a long time, in some cases for many years. This is not harmful, and people who are carrying MDROs can live unaffected by them. However, if a person is already carrying a MDRO they can be at greater risk of developing an infection caused by that pathogen. Individuals who have skin wounds, or an indwelling device like a urinary catheter or percutaneous endoscopic gastrostomy (PEG) feeding tube, or those receiving intravenous or subcutaneous fluids are particularly vulnerable to infection including those caused by an MDRO. Staff caring for individuals who have any indwelling device should have training on how to prevent infections from happening.
If it is known that someone is carrying an MDRO, it is important that this information is shared between ASC and healthcare service providers if the person is transferred between services. This ensures that individuals can be managed safely, and appropriate IPC measures can be put in place to reduce the risk of spreading the MDROs to other people.
Communication and education
Suspected or confirmed multidrug-resistant organism (MDRO) carriage or infection should be included in the individual’s care plan with detailed IPC advice. Always use your usual communication channels to communicate infection status as per local arrangements and maintain confidentiality.
Report or escalate any concerns about the individual’s health to NHS services such as their GP as needed.
Local IPC specialists can give tailored advice for managing MDROs. Care managers should ensure staff can access guidance provided by these specialists or information published by the UK Health Security Agency (UKHSA) and other expert agencies, to explain clearly to staff, individuals, visitors, and families why certain IPC measures are needed.
Care and support workers should take part in IPC training sessions or webinars to strengthen knowledge of IPC precautions and reduce misconceptions about MDROs.
Admissions, re-admissions and visits to ASC settings
It is usually safe to admit or readmit someone with current or previous MDRO carriage. This is because good IPC practices will mitigate against the risk of the organisms spreading to other people. ASC settings are encouraged not to deny admission or readmission solely because of MDRO carriage status. Care managers should carry out a risk assessment to support safe and informed decision-making, consulting the local IPC advisor if required. This will involve deciding which IPC measures can be safely put into place to help mitigate the spread of the MDRO.
There should not be restrictions on visiting a care setting or an individual leaving the setting because of known carriage of any MDROs. See guidance on safer visiting in care homes and seek further IPC advice from the local advisor if required.
How multidrug-resistant organisms spread in adult social care settings
MDROs can spread through direct contact with someone who has an MDRO, or indirect contact from a contaminated surface or object.
Direct contact
When you touch someone with a MDRO – in an infected wound, for example, or if you are washing or dressing them, MDROs can get onto your hands or gloves. If you do not change your gloves and clean your hands properly (see below), you might pass the MDRO to another person you care for.
Indirect contact
MDROs can live on surfaces like bed rails, door handles, toilet seats, and equipment like mobility aids and commodes. If you touch a surface which is contaminated with an MDRO, you could pass this on to someone else that you care for. Alternatively, if you use an item of shared equipment with someone who has an MDRO you could pass the organisms on to the next person who uses it if you do not clean it properly between uses.
Contributing factors
Poor hand hygiene, environmental contamination, failure to clean shared equipment, and incorrect use of sinks can contribute to the risk of transmission of MDROs.
If you do not clean your hands properly after giving care, this can increase the risk of spreading MDROs to another person or onto surfaces such as door handles.
MDROs can live on surfaces for many weeks. Frequent touch points, such as wheelchairs and walking frames, may be more likely to be contaminated. Regular cleaning of high-touch surfaces will minimise the risk of spreading MDROs to other people.
If hand wash sinks are used for anything other than washing hands, for example disposing of body fluids, washing dentures or cleaning sputum cups, or throwing away drinks, splashback from the sink may contaminate the sink and surrounding area.
Key IPC principles for multidrug-resistant organisms
Some people who are colonised with an MDRO may carry it for many years. This means that IPC precautions are particularly important to minimise the risk of spread of MDROs to other people.
MDRO infections can be difficult to manage, but the main IPC principles are the same as for other infections. By consistently following standard IPC measures, you can help stop MDROs from spreading and protect the individuals you support, visitors, and yourself. The key principles below will help you keep the environment safe and manage the risks effectively.
Hand hygiene
The World Health Organization (WHO) promotes hand hygiene as crucial for protecting individuals and staff from infections, including those caused by MDROs. Clean your hands with soap and water or use alcohol-based hand rub before and after providing care or touching another person. You should also clean your hands before handling food, drink or medications, after handling waste, used laundry, or tissues, and after helping an individual in the toilet or the shower, see moments for hand hygiene. It is important that all surfaces of the hands are cleaned, and hand hygiene products are used in the correct way.
The WHO provides detailed instructions on how to use alcohol-based hand rub. See the WHO handrub guidance for more information.
Use soap and water instead of alcohol-based hand rub if the individual has diarrhoea or is vomiting. WHO provide detailed instructions on how to use soap and water to clean hands. See the WHO hand wash guidance for more information.
Make sure the people you support, and any visitors, have access to hand hygiene products and are encouraged to clean their hands. This is especially important before individuals eat or take their medications, after they have coughed or used a tissue, and after they have used the toilet, pan or commode.
If you provide care in someone’s home, carry portable soap or alcohol-based hand rub with you. Clean your hands immediately after leaving their home and before touching anything else, like car keys or your phone.
In residential care homes or day centres, wash your hands or use alcohol-based hand rub when leaving and before touching anything else, like your phone.
Respiratory and cough hygiene
Good respiratory hygiene helps reduce the spread of infections including those caused by MDROs, such as MRSA.
To reduce the spread of infection care and support workers and individuals receiving care should be encouraged to:
- cover their nose and mouth with a disposable tissue when sneezing, coughing, or wiping their nose
- keep tissues within reach and dispose of them immediately after use in a bin
- if tissues are not available, sneeze or cough into their elbow instead of their hands
- clean hands with soap and water or alcohol-based hand rub after coughing, sneezing, using tissues, or touching contaminated objects (for example, sputum pots)
- keep their hands away from their eyes, nose, and mouth if they have respiratory symptoms
- increase ventilation where possible (for example, opening windows) when respiratory infections are suspected or confirmed
Catch it. Bin it. Kill it. is a useful poster to place in ASC settings to remind care and support workers and individuals receiving care of good respiratory hygiene.
More information is available in the Infection prevention and control in adult social care: acute respiratory infection guidance.
Personal protective equipment (PPE)
PPE should be worn if you are likely to come into contact with blood and/or other body fluids, broken skin, mucous membranes, or contaminated surfaces. The recommended PPE includes non-sterile disposable gloves, a disposable plastic apron, and a fluid resistant surgical mask with eye/face protection using goggles or a visor.
If there is no risk of splashing or spraying of blood or body fluids, PPE should consist of non-sterile disposable gloves and a disposable plastic apron.
Use PPE correctly. Make sure you put it on and take it off in the correct order. See the donning and doffing guide. Regular training of putting on and taking off PPE correctly helps you to know how to use PPE to prevent you from contaminating yourself.
Dispose of PPE immediately after each use using the general or household waste bins.
Always wash your hands or use alcohol-based hand rub immediately after removing PPE.
Sinks
In residential care settings and day centres, hand wash sinks should only be used for washing your hands.
- never pour body fluids or waste into hand wash sinks or bedroom sinks
- make sure sinks are in good condition, free from clutter, and cleaned at least once a day
- when supporting or caring for an individual at their home, use the sink that is available
- move any clutter out of the way before washing your hands and do not place care equipment on or near the sink
When providing care in someone’s home, bring your own liquid soap and paper towels so you can wash your hands whenever needed. If the sink is dirty or unsafe, use alcohol-based hand rub until you can access a more suitable handwashing sink.
In residential care and day centre settings, ensure to regularly flush taps and water outlets, especially those that are rarely used, following your local policies. This helps to stop water sitting in pipes for too long where organisms can grow in large numbers and be an infection risk.
Safe management of linen and waste from a person with a multidrug-resistant organism
Linen
It is important that clean linen and clothing is kept separate from used or dirty items at all times. Linen and clothing that has been used by a person who carries a MDRO should be handled, stored, and processed according to usual local policies for laundry management. This generally means that items like sheets and towels are washed at high temperatures and tumble dried. Clothing used by the individual should be washed at as high a temperature as the fabric can tolerate and tumble dried if possible.
In a residential setting:
- if the person has an infection such as a wound infection that is being treated by their GP or other health professional, their clothing and other linen should be classified as infectious linen and managed and segregated as outlined in local policies
- if the laundry equipment can accommodate it, this might mean sealing in a water-soluble bag and immediate placement in an impermeable bag before removal from the individual’s room
There are no special requirements needed for the laundering of clothing and linen used by an individual who has a MDRO if they are in their own home.
Waste
There is generally no need for waste to be treated differently if a person is carrying a MDRO in their own home or in a residential setting.
If waste is produced by a healthcare professional, they will risk assess how the waste should be disposed of based on the healthcare intervention that has taken place. If waste is assessed as hazardous or infectious then the healthcare professionals delivering treatment should take any clinical or hazardous waste generated away with them for safe disposal according to Health Technical Memorandum 07-01: Safe and sustainable management of healthcare waste.
Environmental cleaning and management of shared equipment in residential adult social care settings
Keeping the environment free from dust and debris helps prevent MDROs from spreading, and a tidy environment helps to make cleaning easier to do.
Choose cleaning products appropriate for the material. Products that clean and disinfect in one step are helpful because they reduce the time it takes to effectively clean and disinfect the area. If these are not available, hard surfaces can be disinfected with bleach or bleach alternatives after cleaning with detergent, while soft furnishings should be steam cleaned. Be aware that bleach may damage items it is used on. Always read and follow manufacturer’s instructions when using cleaning and disinfection products.
Set up a cleaning schedule for frequent touch points using disinfectants effective against MDROs and always follow the manufacturer’s instructions.
Clean communal care settings daily using effective detergents and disinfectants to help stop MDROs spreading. Clean high-touch surfaces more often than usual. Focus on areas like door handles, bed rails, light switches, appliance handles and mobile devices like phones and computer keyboards.
In both residential and day care settings there should be designated places where shared equipment is stored between uses, such as storerooms. These spaces should be arranged so that clean and dirty items are kept apart with cleaning equipment close by so it can be used easily. It is not appropriate to store clean equipment in dirty utility areas.
Environmental cleaning and equipment considerations in domiciliary care settings
Providing care in people’s homes comes with challenges, like limited space, varying cleanliness standards and fewer hand hygiene facilities.
Staff providing care and support in home care settings might not usually be responsible for cleaning. However, if a surface may be contaminated and affect the person you are caring for, you should clean it before providing care. If cleaning as part of your role, your organisation will give you clear guidance on what is required.
It may not always be possible to store care equipment safely in the home, and carers may need to transport it. Any equipment that needs to be transported should be thoroughly cleaned between visits. Keep detergent or disinfectant wipes available so you can clean equipment as needed.
Any shared equipment you bring into an individual’s home should be cleaned immediately after use and again before placing it in your vehicle. Clean it once more before storing it until its next use. When storing or transporting items, use a clean, dry, lidded box to prevent contamination.
Providers of loan equipment services should have policies describing the cleaning requirements for equipment.
Social activities and accommodation
It is recommended that any individual living in a residential care setting who is carrying an MDRO is accommodated in a single room with ensuite facilities. They can still take part in communal social and rehabilitation activities and can go to shared spaces like the dining room. This is because the IPC principles described above will mitigate the risk of infection happening to others. Any wounds should be covered with appropriate dressings.
If you provide care or support to people in their own homes, you might be asked to visit individuals with suspected or known MDROs last. However, this is not necessary if IPC measures are followed correctly, and it can even cause harm by delaying essential care.
For example, a person with diabetes needs their food and drink on time. Their care plan should not change just because they carry an MDRO.
If you are unsure, speak with your manager.
People with MDROs do not need to stay away from family members including infants and young children. If there are vulnerable family members, a healthcare professional will risk assess and advise on any precautions, working with the individual and their family.
Antibiotic stewardship
Individuals should only take treatments such as antibiotics, antivirals, antiparasitics or antifungals when they have been prescribed by a healthcare provider. Where antibiotics and similar medications are prescribed, individuals should be supported to start them immediately to reduce the risk of complications or delay in treatment that might lead to the individual getting more ill, or them taking longer to be treated. Support individuals to follow the instructions exactly.
Monitoring and auditing
Adult social care managers should ensure there are systems for regularly checking that IPC practices such as hand hygiene and environmental and equipment cleaning are being followed. Use these checks to spot areas where extra training or support is needed.
When putting IPC measures in place, always consider the risks and consequences carefully. Respect the dignity, autonomy, and confidentiality of individuals. Explain IPC practices clearly and sensitively so that those you care for understand why the measures are necessary and how they can help prevent the spread of MDROs.
Further resources and support
For more information and practical tools please see the following resources or speak with local IPC specialists for tailored advice and support:
Prevention and control of infection in care homes
Infection prevention and control: resource for ASC
NHS England » National standards of healthcare cleanliness 2025
Helping to prevent infection: A quick guide for managers and staff in care homes
Candidozyma auris: information for patients and visitors
Linen processing within adult social care: information sheet
Actions to contain carbapenemase-producing Enterobacterales (CPE)
- Appendix C: How to conduct a risk CPE assessment in non-acute settings
- Appendix J: Frequently asked questions that can be used in local patient information materials has a non-acute care section