Infection control measures to limit antimicrobial resistance

Increasing antimicrobial resistance has resulted in a rapidly decreasing ar ray of therapeutic options for infections in the critical care setting, Rep orts of reduced susceptibility to vancomycin in Staphylococcus aureus raise the possibility of patients being infected with a virulent pathogen for wh ich most antibiotics are ineffective, Infection control methods to contain resistance, exclusive of antimicrobial restrictions, focus on surveillance to identify carriers of resistant organisms, prevention of nosocomial infec tions, adequate hand hygiene, isolation of patients who harbor resistant or ganisms, and the use of barrier techniques such as gowns and gloves, Survei llance using clinical isolates alone is inadequate for the identification o f the majority of patients who carry resistant organisms. However, it is un clear what intensity of surveillance is needed to control the spread of the se organisms in the intensive care unit in nonoutbreak situations, Attempts at eradicating carriage are often unsuccessful when there is extranasal co lonization with methicillin-resistant S, aureus, Transmission of resistant organisms is primarily the result of transient contamination of healthcare workers' hands. Adequate handwashiug, isolation of carriers, and barrier te chniques are all necessary for containing resistance within the intensive c are unit, however, compliance with these measures can be compromised by hig h staff turnover and heavy workload.