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Volumn 13, Issue 5, 2007, Pages 572-577

Interventions to prevent transmission of antimicrobial-resistant bacteria in the intensive care unit

Author keywords

Active surveillance; Contact precautions; Cross infection; Infection control; Methicillin resistant Staphylococcus aureus; Vancomycin resistant Enterococcus

Indexed keywords

CEPHALOSPORIN; CHLORHEXIDINE; CHLORHEXIDINE GLUCONATE; COTRIMOXAZOLE; DOXYCYCLINE; FUSIDIC ACID; IMIPENEM; LEVOFLOXACIN; METICILLIN; NEOMYCIN; OXYTETRACYCLINE; PIPERACILLIN PLUS TAZOBACTAM; PSEUDOMONIC ACID; QUINOLINE DERIVED ANTIINFECTIVE AGENT; RIFAMPICIN; VANCOMYCIN;

EID: 34548414967     PISSN: 10705295     EISSN: 15317072     Source Type: Journal    
DOI: 10.1097/MCC.0b013e3282efc30e     Document Type: Review
Times cited : (16)

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    • Madaras-Kelly KJ, Remington RE, Lewis PG, Stevens DL. Evaluation of an intervention designed to decrease the rate of nosocomial methicillin-resistant Staphylococcus aureus infection by encouraging decreased fluoroquinolone use. Infect Control Hosp Epidemiol 2006; 27:155-169. • A quasi-experimental study of an intervention to reduce fluoroquinolone use found the intervention was associated with a decreased incidence of MRSA infection.
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    • Simor AE, Phillips E, McGeer A, et al. Randomized controlled trial of chlorhexidine gluconate for washing, intranasal mupirocin, and rifampin and doxycycline versus no treatment for the eradication of methicillin-resistant Staphylococcus aureus colonization. Clin Infect Dis 2007; 44:178-185. •• This randomized controlled trial tested a 7-day decolonization (eradication) regimen for hospitalized patients colonized with MRSA. The regimen included chlorhexidine gluconate for bathing, mupirocin ointment applied intranasally, and oral rifampin and doxycycline. Three months after treatment, 74% of treated patients were free of MRSA colonization compared with 32% of untreated patients. Treatment failure was strongly associated with colonization with a strain demonstrating low-level mupirocin resistance 5% prevalence at baseline, Five percent of treated patients who had mupirocin-susceptible isolates at baseline subsequently were colonized with isolates demonstrating
    • Simor AE, Phillips E, McGeer A, et al. Randomized controlled trial of chlorhexidine gluconate for washing, intranasal mupirocin, and rifampin and doxycycline versus no treatment for the eradication of methicillin-resistant Staphylococcus aureus colonization. Clin Infect Dis 2007; 44:178-185. •• This randomized controlled trial tested a 7-day decolonization (eradication) regimen for hospitalized patients colonized with MRSA. The regimen included chlorhexidine gluconate for bathing, mupirocin ointment applied intranasally, and oral rifampin and doxycycline. Three months after treatment, 74% of treated patients were free of MRSA colonization compared with 32% of untreated patients. Treatment failure was strongly associated with colonization with a strain demonstrating low-level mupirocin resistance (5% prevalence at baseline). Five percent of treated patients who had mupirocin-susceptible isolates at baseline subsequently were colonized with isolates demonstrating high-level mupirocin resistance.
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    • Vernon MO, Hayden MK, Trick WE, et al. Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci. Arch Intern Med 2006; 166:306-312. •• This quasi-experimental, sequential study examined the effect of skin cleansing with cloths saturated with 2% chlorhexidine, nonmedicated cloths, soap and water on transmission of VRE in a medical ICU. Compared with use of the nonmedicated cloths and soap and water, cleansing with the chlorhexidine cloths was associated with a decrease in the density of VRE on patients' skin, decreases in contamination of healthcare workers hands and the environment, and a decrease in the incidence of VRE colonization.
    • Vernon MO, Hayden MK, Trick WE, et al. Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci. Arch Intern Med 2006; 166:306-312. •• This quasi-experimental, sequential study examined the effect of skin cleansing with cloths saturated with 2% chlorhexidine, nonmedicated cloths, soap and water on transmission of VRE in a medical ICU. Compared with use of the nonmedicated cloths and soap and water, cleansing with the chlorhexidine cloths was associated with a decrease in the density of VRE on patients' skin, decreases in contamination of healthcare workers hands and the environment, and a decrease in the incidence of VRE colonization.
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    • Sandri AM, Dalarosa MG, Ruschel de Alcantara L, et al. Reduction in incidence of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection in an intensive care unit: role of treatment with mupirocin ointment and chlorhexidine baths for nasal carriers of MRSA. Infect Control Hosp Epidemiol 2006; 27:185-187. • This quasi-experimental study in a general ICU found that the incidence of methicillin-resistant and methicillin- susceptible S. aureus infections were both lower after initiation of intranasal mupirocin and bathing with chlorhexidine.
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