title: Intervention to reduce transmission of resistant bacteria in intensive care.
abstract: BACKGROUND
  Intensive care units (ICUs) are high-risk settings for the transmission of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE).
  
  
  METHODS
  In a cluster-randomized trial, we evaluated the effect of surveillance for MRSA and VRE colonization and of the expanded use of barrier precautions (intervention) as compared with existing practice (control) on the incidence of MRSA or VRE colonization or infection in adult ICUs. Surveillance cultures were obtained from patients in all participating ICUs; the results were reported only to ICUs assigned to the intervention. In intervention ICUs, patients who were colonized or infected with MRSA or VRE were assigned to care with contact precautions; all the other patients were assigned to care with universal gloving until their discharge or until surveillance cultures obtained at admission were reported to be negative.
  
  
  RESULTS
  During a 6-month intervention period, there were 5434 admissions to 10 intervention ICUs, and 3705 admissions to 8 control ICUs. Patients who were colonized or infected with MRSA or VRE were assigned to barrier precautions more frequently in intervention ICUs than in control ICUs (a median of 92% of ICU days with either contact precautions or universal gloving [51% with contact precautions and 43% with universal gloving] in intervention ICUs vs. a median of 38% of ICU days with contact precautions in control ICUs, P<0.001). In intervention ICUs, health care providers used clean gloves, gowns, and hand hygiene less frequently than required for contacts with patients assigned to barrier precautions; when contact precautions were specified, gloves were used for a median of 82% of contacts, gowns for 77% of contacts, and hand hygiene after 69% of contacts, and when universal gloving was specified, gloves were used for a median of 72% of contacts and hand hygiene after 62% of contacts. The mean (±SE) ICU-level incidence of events of colonization or infection with MRSA or VRE per 1000 patient-days at risk, adjusted for baseline incidence, did not differ significantly between the intervention and control ICUs (40.4±3.3 and 35.6±3.7 in the two groups, respectively; P=0.35).
  
  
  CONCLUSIONS
  The intervention was not effective in reducing the transmission of MRSA or VRE, although the use of barrier precautions by providers was less than what was required. (Funded by the National Institute of Allergy and Infectious Diseases and others; STAR*ICU ClinicalTrials.gov number, NCT00100386.).
authors.affiliation: Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: W Charles
authors.initials: WC
authors.lastname: Huskins
authors.forename: Charmaine M
authors.initials: CM
authors.lastname: Huckabee
authors.forename: Naomi P
authors.initials: NP
authors.lastname: O'Grady
authors.forename: Patrick
authors.initials: P
authors.lastname: Murray
authors.forename: Heather
authors.initials: H
authors.lastname: Kopetskie
authors.forename: Louise
authors.initials: L
authors.lastname: Zimmer
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Walker
authors.forename: Ronda L
authors.initials: RL
authors.lastname: Sinkowitz-Cochran
authors.forename: John A
authors.initials: JA
authors.lastname: Jernigan
authors.forename: Matthew
authors.initials: M
authors.lastname: Samore
authors.forename: Dennis
authors.initials: D
authors.lastname: Wallace
authors.forename: Donald A
authors.initials: DA
authors.lastname: Goldmann
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000517:prevention & control / Q000635:transmission*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D016983:Enterococcus / Q000187:drug effects; D017575:Gloves, Protective / Q000706:statistics & numerical data; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission*; D006235:Hand Disinfection; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D055624:Methicillin-Resistant Staphylococcus aureus; D010356:Patient Isolation; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission; D058257:Surgical Attire / Q000706:statistics & numerical data; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents