title: Infection control measures to decrease the burden of antimicrobial resistance in the critical care setting.
abstract: OBJECTIVE
  The prevalence of multidrug-resistant organisms (MDROs) in ICUs is increasing worldwide. This review assesses the role of infection control measures, excluding antibiotic stewardship programs, in reducing the burden of resistance in ICUs.
  
  
  RESULTS
  The knowledge base about the effect of increased hand hygiene compliance in reducing the burden of methicillin-resistant Staphylococcus aureus in ICUs has been improved. Universal decolonization with chlorhexidine body washing was associated with significant reduction in MDRO prevalence, but vigilance for emerging chlorhexidine resistance is required. A significant reduction of resistance for Gram-negative bacilli has been demonstrated with the use of selective decontamination, but further clinical trials are necessary before definitive conclusions can be drawn regarding long-term risk/benefit ratios.
  
  
  CONCLUSIONS
  In the recent years, several high-quality clinical studies have assessed the ability of various infection control measures in reducing the burden of antimicrobial resistance. Significant progress has been made in identifying interventions effective in preventing transmission of MDROs in ICUs, in particular, decolonization. However, it still remains impossible to determine the exact and relative importance of different infection control measures. Any approach must ultimately be tailored to the local epidemiology of the targeted ICU.
authors.affiliation: aInfection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland bInstitute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.
authors.forename: Caroline
authors.initials: C
authors.lastname: Landelle
authors.forename: Kalisvar
authors.initials: K
authors.lastname: Marimuthu
authors.forename: Stephan
authors.initials: S
authors.lastname: Harbarth
mesh_terms: D000900:Anti-Bacterial Agents; D002353:Carrier State / Q000175:diagnosis; D003422:Critical Care / Q000592:standards*; D003428:Cross Infection / Q000517:prevention & control*; D003666:Decontamination / Q000379:methods / Q000592:standards; D004202:Disinfectants; D006235:Hand Disinfection / Q000379:methods; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000592:standards; D007362:Intensive Care Units; D055624:Methicillin-Resistant Staphylococcus aureus / Q000472:pathogenicity; D018570:Risk Assessment; D013203:Staphylococcal Infections / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D004202:Disinfectants