SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus.
BACKGROUND
Infection control programs were created three decades ago to control antibiotic-resistant healthcare-associated infections, but there has been little evidence of control in most facilities. After long, steady increases of MRSA and VRE infections in NNIS System hospitals, the Society for Healthcare Epidemiology of America (SHEA) Board of Directors made reducing antibiotic-resistant infections a strategic SHEA goal in January 2000. After 2 more years without improvement, a SHEA task force was appointed to draft this evidence-based guideline on preventing nosocomial transmission of such pathogens, focusing on the two considered most out of control: MRSA and VRE.


METHODS
Medline searches were conducted spanning 1966 to 2002. Pertinent abstracts of unpublished studies providing sufficient data were included.


RESULTS
Frequent antibiotic therapy in healthcare settings provides a selective advantage for resistant flora, but patients with MRSA or VRE usually acquire it via spread. The CDC has long-recommended contact precautions for patients colonized or infected with such pathogens. Most facilities have required this as policy, but have not actively identified colonized patients with surveillance cultures, leaving most colonized patients undetected and unisolated. Many studies have shown control of endemic and/or epidemic MRSA and VRE infections using surveillance cultures and contact precautions, demonstrating consistency of evidence, high strength of association, reversibility, a dose gradient, and specificity for control with this approach. Adjunctive control measures are also discussed.


CONCLUSIONS
Active surveillance cultures are essential to identify the reservoir for spread of MRSA and VRE infections and make control possible using the CDC's long-recommended contact precautions.
Muto
Carlene A
CA
Division of Hospital Epidemiology and Infection Control, UPMC-P, Pittsburgh, Pennsylvania 15213, USA.
Jernigan
John A
JA
Ostrowsky
Belinda E
BE
Richet
Hervé M
HM
Jarvis
William R
WR
Boyce
John M
JM
Farr
Barry M
BM
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D016983:Enterococcus / Q000187:drug effects*; D004866:Equipment Contamination; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards*; D016106:Methicillin Resistance; D011481:Protective Clothing; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D013211:Staphylococcus aureus / Q000187:drug effects*; D020713:Vancomycin Resistance
D000900:Anti-Bacterial Agents