Theme of the recommendation	Recommended strategies	Comments	Specific responsibilities
Selection of MDRO types	Generally restrict active MDRO surveillance screening to CPE	In accordance with healthcare providers in the LTCFs, other MDROs may be considered for screening	LTCF physicians, LTCF infection preventionists, clinical microbiologists
Selection of LTCF residents	Perform active surveillance cultures (or molecular screening) in the presence of infection by CPE (index case), excluding colonization such as asymptomatic bacteriuria	Screening is especially recommended if the index case is at risk for shedding large numbers of bacteria into the environment, e.g. residents with colonized wounds not fully covered with dressings, incontinent residents with urinary or fecal carriage, or residents with tracheostomies and difficulty in handling respiratory secretions	LTCF physicians, LTCF infection preventionists, Clinical microbiologists
Selection of LTCF residents	Perform active CPE surveillance cultures (or molecular methods) on all residents hosted in the same LTCF unit as the index case	Possible extension of surveillance cultures to other close contacts of the index case in other LTCF units; extension of CPE-screening to all residents of the LTCF can be considered, in agreement with the infection control practitioners in the involved LTCFs	LTCF physicians, LTCF infection preventionists, clinical microbiologists
Specimen types	Use rectal or fecal swabs for CPE-screening	Add other specific specimen types for possible screening of other MDROs	LTCF physicians, LTCF infection preventionists, clinical microbiologists
Frequency of surveillance	Repeat CPE surveillance cultures (or molecular screening) as recommended by the infection control professionals of the LTCF	Discuss frequency of possible surveillance for other MDROs with LTCF infection preventionists	LTCF infection preventionists, clinical microbiologists
Environmental or staff screening	Do not perform routine environmental cultures or screening cultures from asymptomatic personnel	Discuss possible extension of screening to environmental samples or asymptomatic personnel (generally not recommended) with infection preventionists, clinical microbiologists, epidemiologists and infectious disease specialists	LTCF infection preventionists, infectious disease specialists, clinical microbiologists, epidemiologists,
Data elaboration	Integrate active MDRO cultural or molecular screening data from LTCF residents into a general antimicrobial susceptibility data report, comparing screening data from LTCF residents with those from referral ACH patients	If possible, stratify screening data from LTCF residents, admitted within 48 h to the referral ACH, together with LTCF screening data	Clinical microbiologists, epidemiologists,
Isolate conservation	Cryopreserve CPE-isolates (at − 80 °C)	Preserve for further molecular characterization, in collaboration with a reference molecular biology laboratory	Clinical microbiologists