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Siegel JD, Rhinehart E, Jackson M, et al. Management of multidrug-resistant organisms in healthcare settings. Atlanta, GA: Centers for Disease Control and Prevention Healthcare Infection Control Practices Advisory Committee; 2006; 2006. • The HICPAC guideline recommends a hierarchy of interventions, with the use of active surveillance if other approaches have failed to control transmission adequately.
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Siegel JD, Rhinehart E, Jackson M, et al. Management of multidrug-resistant organisms in healthcare settings. Atlanta, GA: Centers for Disease Control and Prevention Healthcare Infection Control Practices Advisory Committee; 2006; 2006. • The HICPAC guideline recommends a hierarchy of interventions, with the use of active surveillance if other approaches have failed to control transmission adequately.
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Strausbaugh LJ, Siegel JD, Weinstein RA. Preventing transmission of multidrug-resistant bacteria in healthcare settings: a tale of 2 guidelines. Clin Infect Dis 2006; 42:828-835.
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Two studies feed the debate on active surveillance for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci carriage: To screen or not to screen?
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Talbot TR. Two studies feed the debate on active surveillance for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci carriage: to screen or not to screen? J Infect Dis 2007; 195: 314-317.
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Gerber SI, Jones RC, Scott MV, et al. Management of outbreaks of methicillin-resistant Staphylococcus aureus infection in the neonatal intensive care unit: a consensus statement. Infect Control Hosp Epidemiol 2006; 27:139-145. • This consensus statement comes from a group of collaborators in Chicago regarding the control of MRSA in neonatal ICUs. The document recommends routine periodic screening with an increased intensity of screening when clusters of MRSA are identified.
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Gerber SI, Jones RC, Scott MV, et al. Management of outbreaks of methicillin-resistant Staphylococcus aureus infection in the neonatal intensive care unit: a consensus statement. Infect Control Hosp Epidemiol 2006; 27:139-145. • This consensus statement comes from a group of collaborators in Chicago regarding the control of MRSA in neonatal ICUs. The document recommends routine periodic screening with an increased intensity of screening when clusters of MRSA are identified.
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To catch a deadly germ
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Legislative mandates for use of active surveillance cultures to screen for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci: Position statement from the Joint SHEA and APIC Task Force
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• This position statement from a joint SHEA and APIC Task Force opposes legislation mandating active surveillance
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Weber SG, Huang SS, Oriola S, et al. Legislative mandates for use of active surveillance cultures to screen for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci: position statement from the Joint SHEA and APIC Task Force. Am J Infect Control 2007; 35:73-85. • This position statement from a joint SHEA and APIC Task Force opposes legislation mandating active surveillance.
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Am J Infect Control
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Weber, S.G.1
Huang, S.S.2
Oriola, S.3
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Legislative mandates for use of active surveillance cultures to screen for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci: Position statement from the Joint SHEA and APIC Task Force
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• This position statement from a joint SHEA and APIC Task Force opposes legislation mandating active surveillance
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Weber SG, Huang SS, Oriola S, et al. Legislative mandates for use of active surveillance cultures to screen for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci: position statement from the Joint SHEA and APIC Task Force. Infect Control Hosp Epidemiol 2007; 28:249-260. • This position statement from a joint SHEA and APIC Task Force opposes legislation mandating active surveillance.
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Infect Control Hosp Epidemiol
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Weber, S.G.1
Huang, S.S.2
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Farr BM. Political versus epidemiological correctness. Infect Control Hosp Epidemiol 2007; 28:589-593.
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Fraser V, Murphy D, Brennan PJ, et al. Politically incorrect: legislation must not mandate specific healthcare epidemiology and infection prevention and control practices. Infect Control Hosp Epidemiol 2007; 28:594-595.
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Voluntary Hospital Association. VHA's accelerated improvement network: eliminating MRSA. https://www.vha.com/portal/server.pt/gateway/ PTARGS_0_2_202_0_0_35/http%3B/remote.vha.com/public/productsservices/clinical/ mrsa.asp. [Accessed 11 March 2007]
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National Health Service. The delivery programme to reduce healthcare associated infections (HCAI) including MRSA. http://www.dh.gov.uk/en/ Policyandguidance/Healthandsocialcaretopics/Healthcareacquiredinfection/ Healthcareacquiredgeneralinformation/ ThedeliveryprogrammetoreducehealthcareassociatedinfectionsHCAIincludingMRSA/ index.htm. [Accessed 11 March 2007]
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Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units
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•• A multicenter retrospective study conducted by the CDC Epicenters Program that documents that active surveillance for MRSA in ICUs identified substantially more colonized patients than were recognized by cultures obtained for clinical indications alone
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Huang SS, Rifas-Shiman SL, Warren DK, et al. Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units. J Infect Dis 2007; 195:330-338. •• A multicenter retrospective study conducted by the CDC Epicenters Program that documents that active surveillance for MRSA in ICUs identified substantially more colonized patients than were recognized by cultures obtained for clinical indications alone.
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(2007)
J Infect Dis
, vol.195
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Huang, S.S.1
Rifas-Shiman, S.L.2
Warren, D.K.3
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Improving the assessment of vancomycin-resistant enterococci by routine screening
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•• This multicenter retrospective study by the CDC Epicenters Program that documented that active surveillance for VRE in ICUs identified substantially more colonized patients than were recognized by cultures obtained for clinical indications alone
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Huang SS, Rifas-Shiman SL, Pottinger JM, et al. Improving the assessment of vancomycin-resistant enterococci by routine screening. J Infect Dis 2007; 195:339-346. •• This multicenter retrospective study by the CDC Epicenters Program that documented that active surveillance for VRE in ICUs identified substantially more colonized patients than were recognized by cultures obtained for clinical indications alone.
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(2007)
J Infect Dis
, vol.195
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Huang, S.S.1
Rifas-Shiman, S.L.2
Pottinger, J.M.3
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Huang SS, Yokoe DS, Hinrichsen VL, et al. Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2006; 43:971-978. •• A quasi-experimental study in one institution (eight ICUs) retrospectively evaluated the effect of four sequential interventions on the incidence of hospital associated and overall MRSA bacteremia over a 9-year period using interrupted time series analysis. The incidence of MRSA bacteremia decreased substantially among ICU patients, non-ICU patients and all patients hospital-wide after initiation of active surveillance for MRSA in ICU patients.
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Huang SS, Yokoe DS, Hinrichsen VL, et al. Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2006; 43:971-978. •• A quasi-experimental study in one institution (eight ICUs) retrospectively evaluated the effect of four sequential interventions on the incidence of hospital associated and overall MRSA bacteremia over a 9-year period using interrupted time series analysis. The incidence of MRSA bacteremia decreased substantially among ICU patients, non-ICU patients and all patients hospital-wide after initiation of active surveillance for MRSA in ICU patients.
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Singh N, Squier C, Wannstedt C, et al. Impact of an aggressive infection control strategy on endemic Staphylococcus aureus infection in liver transplant recipients. Infect Control Hosp Epidemiol 2006; 27:122-126. • This report describes a quasi-experimental (before-after) study in liver transplant patients of an MRSA control program including active surveillance, contact precautions and cohorting, and intranasal mupirocin at the time of transplant. The incidence of new MRSA colonization, MRSA bacteremias, and all MRSA infections regardless of site decreased after the initiation of the program.
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Singh N, Squier C, Wannstedt C, et al. Impact of an aggressive infection control strategy on endemic Staphylococcus aureus infection in liver transplant recipients. Infect Control Hosp Epidemiol 2006; 27:122-126. • This report describes a quasi-experimental (before-after) study in liver transplant patients of an MRSA control program including active surveillance, contact precautions and cohorting, and intranasal mupirocin at the time of transplant. The incidence of new MRSA colonization, MRSA bacteremias, and all MRSA infections regardless of site decreased after the initiation of the program.
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Warren DK, Guth RM, Coopersmith CM, et al. Impact of a methicillin-resistant Staphylococcus aureus active surveillance program on contact precaution utilization in a surgical intensive care unit. Crit Care Med 2007; 35:430-434. • This prospective cohort study found that contact precaution days increased 6% after initiation of active surveillance.
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Warren DK, Guth RM, Coopersmith CM, et al. Impact of a methicillin-resistant Staphylococcus aureus active surveillance program on contact precaution utilization in a surgical intensive care unit. Crit Care Med 2007; 35:430-434. • This prospective cohort study found that contact precaution days increased 6% after initiation of active surveillance.
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Harbarth S, Masuet-Aumatell C, Schrenzel J, et al. Evaluation of rapid screening and preemptive contact isolation for detecting and controlling methicillin-resistant Staphylococcus aureus in critical care: an interventional cohort study. Crit Care 2006; 10:R25. This report describes a quasi-experimental study of the sequential implementation of a PCR rapid test for active surveillance and preemptive contact precaution for MRSA in one medical and one surgical ICU. Turnaround time for PCR was much faster than culture-based screening and was associated with a substantial reduction in preemptive contact precaution days. The incidence of MRSA infection was lower in the medical ICU but unchanged in the surgical ICU.
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Harbarth S, Masuet-Aumatell C, Schrenzel J, et al. Evaluation of rapid screening and preemptive contact isolation for detecting and controlling methicillin-resistant Staphylococcus aureus in critical care: an interventional cohort study. Crit Care 2006; 10:R25. This report describes a quasi-experimental study of the sequential implementation of a PCR rapid test for active surveillance and preemptive contact precaution for MRSA in one medical and one surgical ICU. Turnaround time for PCR was much faster than culture-based screening and was associated with a substantial reduction in preemptive contact precaution days. The incidence of MRSA infection was lower in the medical ICU but unchanged in the surgical ICU.
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33846874344
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Trick WE, Vernon MO, Welbel SF, et al. Multicenter intervention program to increase adherence to hand hygiene recommendations and glove use and to reduce the incidence of antimicrobial resistance. Infect Control Hosp Epidemiol 2007; 28:42-49. • This quasi-experimental study of a mulimodal intervention demonstrated a sustained improvement in compliance with hand hygiene and glove use in three facilities that implemented the entire intervention. The incidence of some resistant Gram negative rods and MRSA was reduced in the facility that demonstrated the largest improvement in compliance.
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Trick WE, Vernon MO, Welbel SF, et al. Multicenter intervention program to increase adherence to hand hygiene recommendations and glove use and to reduce the incidence of antimicrobial resistance. Infect Control Hosp Epidemiol 2007; 28:42-49. • This quasi-experimental study of a mulimodal intervention demonstrated a sustained improvement in compliance with hand hygiene and glove use in three facilities that implemented the entire intervention. The incidence of some resistant Gram negative rods and MRSA was reduced in the facility that demonstrated the largest improvement in compliance.
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The impact of gown-use requirement on hand hygiene compliance
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• A cross-over study in two ICUs in found no effect of the use of gowns on compliance with hand hygiene
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Golan Y, Doron S, Griffith J, et al. The impact of gown-use requirement on hand hygiene compliance. Clin Infect Dis 2006; 42:370-376. • A cross-over study in two ICUs in found no effect of the use of gowns on compliance with hand hygiene.
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(2006)
Clin Infect Dis
, vol.42
, pp. 370-376
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Golan, Y.1
Doron, S.2
Griffith, J.3
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The role of gowns in preventing nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA): Gown use in MRSA control
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• A quasi-experimental study found no effect of the use of gowns on transmission of MRSA
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Grant J, Ramman-Haddad L, Dendukuri N, Libman MD. The role of gowns in preventing nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA): gown use in MRSA control. Infect Control Hosp Epidemiol 2006; 27:191-194. • A quasi-experimental study found no effect of the use of gowns on transmission of MRSA.
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(2006)
Infect Control Hosp Epidemiol
, vol.27
, pp. 191-194
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Grant, J.1
Ramman-Haddad, L.2
Dendukuri, N.3
Libman, M.D.4
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Evaluation of compliance with preventive barrier precautions to control meticillin-resistant Staphylococcus aureus cross-transmission in four nonintensive acute-care wards of a French teaching hospital
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Eveillard M, Grandin S, Zihoune N, et al. Evaluation of compliance with preventive barrier precautions to control meticillin-resistant Staphylococcus aureus cross-transmission in four nonintensive acute-care wards of a French teaching hospital. J Hosp Infect 2007; 65:81-83.
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(2007)
J Hosp Infect
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Eveillard, M.1
Grandin, S.2
Zihoune, N.3
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Look before you leap: Active surveillance for multidrug-resistant organisms
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• This is a thoughtful review of practical concerns related to the use of active surveillance and contact precautions to control spread of MRSA and VRE in inpatient settings
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Diekema DJ, Edmond MB. Look before you leap: active surveillance for multidrug-resistant organisms. Clin Infect Dis 2007; 44:1101-1107. • This is a thoughtful review of practical concerns related to the use of active surveillance and contact precautions to control spread of MRSA and VRE in inpatient settings.
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(2007)
Clin Infect Dis
, vol.44
, pp. 1101-1107
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Diekema, D.J.1
Edmond, M.B.2
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Risk of acquiring antibiotic-resistant bacteria from prior room occupants
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• This retrospective cohort study found an increased risk of acquisition of MRSA or VRE in patients occupying a room previously occupied by colonized patient
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Huang SS, Datta R, Platt R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006; 166:1945-1951. • This retrospective cohort study found an increased risk of acquisition of MRSA or VRE in patients occupying a room previously occupied by colonized patient.
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(2006)
Arch Intern Med
, vol.166
, pp. 1945-1951
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Huang, S.S.1
Datta, R.2
Platt, R.3
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A study of the relationship between environmental contamination with methicillin-resistant Staphylococcus aureus (MRSA) and patients' acquisition of MRSA
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• This report describes a prospective study of the acquisition of MRSA with molecular typing of patient and environmental isolates
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Hardy KJ, Oppenheim BA, Gossain S, et al. A study of the relationship between environmental contamination with methicillin-resistant Staphylococcus aureus (MRSA) and patients' acquisition of MRSA. Infect Control Hosp Epidemiol 2006; 27:127-132. • This report describes a prospective study of the acquisition of MRSA with molecular typing of patient and environmental isolates.
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(2006)
Infect Control Hosp Epidemiol
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, pp. 127-132
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Hardy, K.J.1
Oppenheim, B.A.2
Gossain, S.3
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Reduction in acquisition of vancomycin-resistant Enterococcus after enforcement of routine environmental cleaning measures
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•• A quasi-experimental study of an intervention to improve environmental cleaning in a medical ICU found that the intervention was associated with a two-fold increase in the number of environmental sites that were cleaned appropriately and a reduced risk of acquisition of VRE
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Hayden MK, Bonten MJ, Blom DW, et al. Reduction in acquisition of vancomycin-resistant Enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis 2006; 42:1552-1560. •• A quasi-experimental study of an intervention to improve environmental cleaning in a medical ICU found that the intervention was associated with a two-fold increase in the number of environmental sites that were cleaned appropriately and a reduced risk of acquisition of VRE.
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(2006)
Clin Infect Dis
, vol.42
, pp. 1552-1560
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Hayden, M.K.1
Bonten, M.J.2
Blom, D.W.3
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Madaras-Kelly KJ, Remington RE, Lewis 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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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
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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 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.
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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.
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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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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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Gould IM, MacKenzie FM, MacLennon G, et al. Topical antimicrobials in combination with admission screening and barrier precautions to control endemic methicillin-resistant Staphylococcus aureus in an intensive care unit. Int J Antimicrob Agents 2007; 29:536-543. • A quasi-experimental study in a medical-surgical ICU evaluated the effect of active surveillance, intranasal topical antimicrobial agents 2% fusidic acid, 3% oxytetracycline, 0.5% neomycin plus 0.1% chlorhexidine hydrochloride used on a weekly, rotating basis, and daily bathing with 4% chlorhexidine gluconate on MRSA colonization and infection over a 4-year period. The authors used interrupted time series analysis to analyze their data. The percentage of patients identified with MRSA was lower during the intervention period, although systematic screening was not performed during the baseline period or at the time of discharge so these data are difficult to interpret. The percentages of patients with MRSA, methic
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Gould IM, MacKenzie FM, MacLennon G, et al. Topical antimicrobials in combination with admission screening and barrier precautions to control endemic methicillin-resistant Staphylococcus aureus in an intensive care unit. Int J Antimicrob Agents 2007; 29:536-543. • A quasi-experimental study in a medical-surgical ICU evaluated the effect of active surveillance, intranasal topical antimicrobial agents (2% fusidic acid, 3% oxytetracycline, 0.5% neomycin plus 0.1% chlorhexidine hydrochloride used on a weekly, rotating basis), and daily bathing with 4% chlorhexidine gluconate on MRSA colonization and infection over a 4-year period. The authors used interrupted time series analysis to analyze their data. The percentage of patients identified with MRSA was lower during the intervention period, although systematic screening was not performed during the baseline period or at the time of discharge so these data are difficult to interpret. The percentages of patients with MRSA, methicillin-susceptible S. aureus, and coagulase negative staphylococcal bacteremia were all lower during the intervention period, but only the difference in coagulase negative staphylococcal bacteremia was statistically significant.
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