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SHEA Guideline for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of Staphylococcus aureus and Enterococcus

Published online by Cambridge University Press:  02 January 2015

Carlene A. Muto ,
John A. Jernigan ,
Belinda E. Ostrowsky ,
Hervé M. Richet ,
William R. Jarvis ,
John M. Boyce  and
Barry M. Farr
Carlene A. Muto*
Affiliation:
Division of Hospital Epidemiology and Infection Control, UPMC-P, and the Infectious Diseases Epidemiology Research Unit, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania
John A. Jernigan
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Belinda E. Ostrowsky
Affiliation:
Virginia Commonwealth University, Richmond, Virginia
Hervé M. Richet
Affiliation:
Hospital of Nantes, Nantes, France
William R. Jarvis
Affiliation:
National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
John M. Boyce
Affiliation:
Division of Hospital Epidemiology, Hospital of St. Raphael, and Infectious Diseases, Yale University, New Haven, Connecticut
Barry M. Farr
Affiliation:
University of Virginia Health System, Charlottesville, Virginia
*
Infection Control and Hospital Epidemiology, University of Pittsburgh Medical Center – Presbyterian, 3471 Fifth Street, 1215 Kaufmann Building, Pittsburgh, PA 15213
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Abstract

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 Pertinent abstracts of unpublished studies providing sufficient data were included.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.

Conclusion:

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.

Type
Special Report
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 5 , May 2003 , pp. 362 - 386
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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