Apa yang Harus Dipahami Perawat Tentang Pencegahan Nosokomial Terkait Multidrug-Resistant Organisms (MDROS)?

  • Rustiana Tasya Ariningpraja Universitas Airlangga
  • Ika Yuni Widyawati Universitas Airlangga, Surabaya, Indonesia
  • Endah Panca Lydia Fatma Universitas Airlangga, Surabaya, Indonesia


This study aims to determine the important role of critical care nurses in preventing nosocomial infections caused by Multidrug-Resistant Organisms (MDROs). This review conducted a systematic search of electronic databases including PubMed, Scopus, CINAHL, Web of Science (WoS), and ScienceDirect, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. As a result of the study, Chlorhexidine baths, oral care, and environmental cleaning were identified as the most effective strategies for preventing MDROs in critical care settings and the impact of these strategies varied across studies. Caps containing alcohol to prevent bloodstream infections have also been shown to be effective. In conclusion, this review highlights the importance of implementing effective prevention strategies to reduce the incidence of MDROs in critical care settings. Critical care nurses must know the most effective strategies for preventing infections and implement them consistently. The findings of this review have important implications for clinical practice and policy development.


Keywords: Intensive Care Unit; Nosocomial Infections, Multidrug-Resistant Organisms (MDROS), Critical Care Nursing


Alrebish, S. A., Yusufoglu, H. S., Alotibi, R. F., Abdulkhalik, N. S., Ahmed, N. J., & Khan, A. H. (2022, December). Epidemiology of Healthcare-Associated Infections and Adherence to the HAI Prevention Strategies. In Healthcare, 119(1), 63. MDPI. 10.3390/healthcare11010063

Amir-Behghadami M, Janati A. Population, Intervention, Comparison, Outcomes and Study (PICOS) design as a framework to formulate eligibility criteria in systematic reviews. Emerg Med J, 37(6):387–387. https://emj.bmj.com/lookup/doi/10.1136/emermed-2020-20956

Blot, S., Ruppé, E., Harbarth, S., Asehnoune, K., Poulakou, G., Luyt, C. E., ... & Zahar, J. R. (2022). Healthcare-Associated Infections in Adult Intensive Care Unit Patients: Changes in Epidemiology, Diagnosis, Prevention and Contributions of New Technologies. Intensive and Critical Care Nursing, 70, 103227. https://doi.org/10.1016/j.iccn.2022.103227

Blanco, N., O’Hara, L. M., & Harris, A. D. (2019). Transmission Pathways of Multidrug-Resistant Organisms in the Hospital Setting: A Scoping Review. Infection Control & Hospital Epidemiology, 40(4), 447-456. https://doi.org/10.1017/ice.2018.359

CDC. Antibiotic Resistance Threats in The United States 2019. Cdc. 2019;10(1). https://www.cdc.gov/drugresistance/biggest-threats.html

Climo, M. W., Yokoe, D. S., Warren, D. K., Perl, T. M., Bolon, M., Herwaldt, L. A., ... & Wong, E. S. (2013). Effect of Daily Chlorhexidine Bathing on Hospital-Acquired Infection. New England Journal of Medicine, 368(6), 533-542. 10.1056/NEJMoa1113849

Chiewchalermsri, C., Sompornrattanaphan, M., Wongsa, C., & Thongngarm, T. (2020). Chlorhexidine Allergy: Current Challenges and Future Prospects. Journal of asthma and allergy, 127-133. https://doi.org/10.2147/JAA.S207980

Dadi, N. C. T., Radochová, B., Vargová, J., & Bujdáková, H. (2021). Impact of Healthcare-Associated Infections Connected to Medical Devices—An Update. Microorganisms, 9(11), 2332. 10.3390/microorganisms9112332

Dale, C. M., Rose, L., Carbone, S., Ruxandra, P., Smith, O. M., Burry, L., ... & Cuthbertson, B. H. (2021). Effect of Oral Chlorhexidine De-Adoption and Implementation of An Oral Care Bundle on Mortality for Mechanically Ventilated Patients in The Intensive Care Unit (CHORAL): A Multi-Center Stepped Wedge Cluster-Randomized Controlled Trial. Intensive Care Medicine, 47(11), 1295-1302. https://doi.org/10.1007/s00134-021-06475-2

De Waele, J. J., Boelens, J., & Leroux-Roels, I. (2020). Multidrug-Resistant Bacteria in ICU: Fact or Myth. Current Opinion in Anesthesiology, 33(2), 156-161.. 10.1097/ACO.00000000000008306.

G Giuliano, K. K., Penoyer, D., Middleton, A., & Baker, D. (2021). Oral Care as Prevention for Nonventilator Hospital-Acquired Pneumonia: A Four-Unit Cluster Randomized Study. AJN The American Journal of Nursing, 121(6), 24-33. https://doi.org/10.1097/01.naj.0000753468.99321.93

Huang, S. S., Septimus, E., Kleinman, K., Moody, J., Hickok, J., Heim, L., ... & Platt, R. (2019). Chlorhexidine Versus Routine Bathing to Prevent Multidrug-Resistant Organisms and All-Cause Bloodstream Infections in General Medical and Surgical Units (ABATE Infection Trial): A Cluster-Randomised Trial. The Lancet, 393(10177), 1205-1215. https://doi.org/10.1016/S0140-6736(18)32593-5

Jia, H., Li, W., Hou, T., Ma, H., Yang, Y., Wu, A., ... & Li, L. (2019). The Attributable Direct Medical Cost of Healthcare Associated Infection Caused by Multidrug Resistance Organisms in 68 Hospitals of China. Biomed Research International, 2019, 7634528-7634528. https://doi.org/10.1155/2019/7634528

Kurniawati, A. F., Satyabakti, P., & Arbianti, N. (2015). Risk Difference of Multidrug Resistance Organisms (MDROs) According to Risk Factor and Hand Hygiene Compliance. Jurnal Berkala Epidemiologi, 3(3), 277-289. https://doi.org/10.20473/jbe.V3I32015.277-289

Mirande, C., Bizine, I., Giannetti, A., Picot, N., & van Belkum, A. (2018). Epidemiological Aspects of Healthcare-Associated Infections and Microbial Genomics. European Journal of Clinical Microbiology & Infectious Diseases, 37(5). https://doi.org/10.1007/s10096-017-3170-x

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., ... & Moher, D. (2021). The PRISMA 2020 Statement: an Updated Guideline for Reporting Systematic Reviews. International journal of surgery, 88, 105906. DOI:10.1371/journal.pmed.100358313.

Riley, M. M. S. (2019). The Rising Problem of Multidrug-Resistant Organisms in Intensive Care Units. Critical care nurse, 39(4), 48-55. https://doi.org/10.4037/ccn2019773

Rodríguez-Villodres, Á., Martín-Gandul, C., Peñalva, G., Guisado-Gil, A. B., Crespo-Rivas, J. C., Pachón-Ibáñez, M. E., ... & Cisneros, J. M. (2021). Prevalence and Risk Factors for Multidrug-Resistant Organisms Colonization in Long-Term Care Facilities Around the World: a review. Antibiotics, 10(6), 680. https://doi.org/10.3390/antibiotics1006068

Sodhi, K., Shrivastava, A., Arya, M., & Kumar, M. (2013). Knowledge of Infection Control Practices Among Intensive Care Nurses in A Tertiary Care Hospital. Journal of infection and public health, 6(4), 269-275. 10.1016/j.jiph.2013.02.004

Taşdelen Öğülmen, D., & Ateş, S. (2021). Use of Alcohol Containing Caps for Preventing Bloodstream Infections: A Randomized Controlled Trial. The Journal of Vascular Access, 22(6), 920-925. https://doi.org/10.1177/1129729820952961

Tschudin-Sutter, S., Pargger, H., & Widmer, A. F. (2010). Hand Hygiene in the Intensive Care Unit. Critical care medicine, 38, S299-S305. 10.1097/CCM.0b013e3181e6a23f

Van den Poel, B., Saegeman, V., & Schuermans, A. (2022). Increasing Usage of Chlorhexidine in Health Care Settings: Blessing or Curse? A Narrative Review of the Risk of Chlorhexidine Resistance and the Implications for Infection Prevention And Control. European Journal of Clinical Microbiology & Infectious Diseases, 41(3), 349-362. https://doi.org/10.1007/s10096-022-04403-

von Lengerke, T., Ebadi, E., Schock, B., Krauth, C., Lange, K., Stahmeyer, J. T., & Chaberny, I. F. (2019). Impact of Psychologically Tailored Hand Hygiene Interventions on Nosocomial Infections with Multidrug-Resistant Organisms: Results of The Cluster-Randomized Controlled Trial PSYGIENE. Antimicrobial Resistance & Infection Control, 8, 1-11. DOI: 10.1186/s13756-019-0507-5

Warrier, A., & Jasmine, N. (2014). A Prospective Evaluation of Interventions to Reduce the MDRO Rate in ICU. International Journal of Infectious Diseases, 21, 415. https://doi.org/10.1016/j.ijid.2014.03.1277

Zamir, N., Pook, M., McDonald, E., & Fox-Robichaud, A. E. (2020). Chlorhexidine Locking Device for Central Line Infection Prevention in ICU Patients: Protocol For An Open-Label Pilot and Feasibility Randomized Controlled Trial. Pilot and Feasibility Studies, 6(1), 1-10. https://doi.org/10.1186/s40814-020-0564-9

Zil Zilahi, G., Artigas, A., & Martin-Loeches, I. (2016). What’s New in Multidrug-Resistant Pathogens in the ICU?. Annals of intensive care, 6(1), 1-11. https://doi.org/10.1186/s13613-016-0199-4

Zhao, T., Wu, X., Zhang, Q., Li, C., Worthington, H. V., & Hua, F. (2020). Oral Hygiene Care for Critically Ill Patients to Prevent Ventilator‐Associated Pneumonia. Cochrane Database Of Systematic Reviews, (12). https://doi.org/10.1002/14651858.CD008367.pub4
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