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Strategies to Prevent Transmission of Methicillin-Resistant Staphylococcus aureus in Acute Care Hospitals

  • David P. Calfee (a1), Cassandra D. Salgado (a2), David Classen (a3), Kathleen M. Arias (a4), Kelly Podgorny (a5), Deverick J. Anderson (a6), Helen Burstin (a7), Susan E. Coffin (a8), Erik R. Dubberke (a9), Victoria Fraser (a9), Dale N. Gerding (a10) (a11), Frances A. Griffin (a12), Peter Gross (a13) (a14), Keith S. Kaye (a6), Michael Klompas (a15), Evelyn Lo (a16), Jonas Marschall (a9), Leonard A. Mermel (a17), Lindsay Nicolle (a16), David A. Pegues (a18), Trish M. Perl (a19), Sanjay Saint (a20), Robert A. Weinstein (a21), Robert Wise (a5) and Deborah S. Yokoe (a15)...

Extract

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). Our intent in this document is to highlight practical recommendations in a concise format to assist acute care hospitals in their efforts to prevent transmission of methicillin-resistant Staphylococcus aureus (MRSA). Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary, Introduction, and accompanying editorial for additional discussion.

1. Burden of HAIs caused by MRSA in acute care facilities

a. In the United States, the proportion of hospital-associated S. aureus infections that are caused by strains resistant to methicillin has steadily increased. In 2004, MRSA accounted for 63% of S. aureus infections in hospitals.

b. Although the proportion of S. aureus–associated HAIs among intensive care unit (ICU) patients that are due to methicillin-resistant strains has increased (a relative measure of the MRSA problem), recent data suggest that the incidence of central line–associated bloodstream infection caused by MRSA (an absolute measure of the problem) has decreased in several types of ICUs since 2001. Although these findings suggest that there has been some success in preventing nosocomial MRSA transmission and infection, many patient groups continue to be at risk for such transmission.

c. MRSA has also been documented in other areas of the hospital and in other types of healthcare facilities, including those that provide long-term care.

Copyright

Corresponding author

University of Chicago Press, 1427 E. 60th St., Chicago, IL 60637 (reprints@press.uchicago.edu) or contact the journal office (iche@press.uchicago.edu).

References

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1. Centers for Disease Control and Prevention. MRSA in healthcare settings. Available at: http://www.cdc.gov/ncidod/dhqp/ar_MRSA_spotlight_2006.html. Accessed August 7, 2008.
2.Burton, DC, Edwards, JR, Fridkin, SK. Comparison of measures of MRSA related to central line-associated bloodstream infections in intensive care units—United States, 1997–2007. Abstract for SHEA 18th Annual Scientific Meeting late breaker. Available at: http://www.cdc.gov/nci-dod/dhqp/SHEA_Abstract4.html. Accessed August 7, 2008.
3.Cosgrove, S, Sakoulas, G, Perencevich, E, Schwaber, M, Karchmer, A, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and mefhicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003;36:5359.
4.Engemann, J, Carmeli, Y, Cosgrove, S, et al.Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36:592598.
5.Abramson, M, Sexton, D. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol 1999;20:408411.
6.Cosgrove, S, Qi, Y, Kaye, K, Harbarth, S, Karchmer, A, Carmeli, Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26:166174.
7.Huang, S, Platt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003;36:281285.
8.Garrouste-Orgeas, M, Timsit, J, Kallel, H, et al.Colonization with methicillin-resistant Staphylococcus aureus in ICU patients: morbidity, mortality, and glycopeptide use. Infect Control Hosp Epidemiol 2001;22:687692.
9.Merrer, J, Santoli, F, Appéré-De Vecchi, C, Tran, B, De Jonghe, B, Outin, H. “Colonization pressure” and risk of acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol 2000;21:718723.
10.Moran, G, Krishnadasan, A, Gorwitz, R, et al.Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 2006;355:666674.
11.King, M, Humphrey, B, Wang, Y, Kourbatova, E, Ray, S, Blumberg, H. Emergence of community-acquired methicillin-resistant Staphylococcus aureus USA 300 clone as the predominant cause of skin and soft-tissue infections. Ann Intern Med 2006;144:309317.
12.Maree, C, Daum, R, Boyle-Vavra, S, Matayoshi, K, Miller, L. Community-associated methicillin-resistant Staphylococcus aureus isolates causing healthcare-associated infection. Emerg Infect Dis 2007;13:236242.
13.Klevens, R, Morrison, M, Nadle, J, et al.Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298:17631771.
14.Bhalla, A, Pultz, N, Gries, D, et al.Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients. Infect Control Hosp Epidemiol 2004;25:164167.
15.Smith, M, Mathewson, J, Ulert, I, Scerpella, E, Ericsson, C. Contaminated stethoscopes revisited. Arch Intern Med 1996;156:8284.
16.Cohen, H, Liora, H, Paret, G, Lahat, E, Kennet, G, Barzilai, A. Aurioscope earpieces—a potential vector of infection? Int J Pediatr Otorhinolaryngol 1998;45:4750.
17.Bernard, L, Kereveur, A, Durand, D, et al.Bacterial contamination of hospital physicians' stethoscopes. Infect Control Hosp Epidemiol 1999;20:626628.
18.Embil, J, McLeod, J, Al-Barrak, A, et al.An outbreak of methicillin resistant Staphylococcus aureus on a burn unit: potential role of contaminated hydrotherapy equipment. Burns 2001;27:681688.
19.Breathnach, A, Jenkins, D, Pedler, S. Stethoscopes as possible vectors of infection by staphylococci. BMJ 1992;305:15731574.
20.Cohen, A, Calfee, D, Fridkin, S, et al. Recommendations for multidrug-resistant organisms metrics in healthcare settings: SHEA/HICPAC position paper. Infect Control Hosp Epidemiol (in press).
21.Muto, C, Jernigan, J, Ostrowsky, B, et al.SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24:362386.
22.Siegel, J, Rhinehart, E, Jackson, M, Chiarello, L, Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings, 2006. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/ar/MDROGuideline2006.pdf. Accessed July 8, 2008.
23.Coia, J, Duckworth, G, Edwards, D, et al.Guidelines for the control and prevention of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect 2006;63(Suppl 1):S1S44.
24. Infection Prevention Working Party. MRSA hospital. January 2007. Available at: http://www.wip.nl/UK/contentbrowser/onderwerpsort.asp?expca=1&exppa=1&expow=22&sortby=titel&sortdn=0#HIER. Accessed August 25, 2008.
25. Institute for Healthcare Improvement. How-to guide: reduce methicillin-resistant Staphylococcus aureus (MRSA) infection. 2006. Available at: http://www.ihi.org/IHI/Programs/Campaign/. Accessed July 8, 2008.
26.Association for Professionals in Infection Control and Epidemiology. Guide to the elimination of methicillin-resistant Staphylococcus aureus (MRSA) transmission in hospital settings. Washington, DC: Association for Professionals in Infection Control and Epidemiology; 2007.
27.Canadian Task Force on the Periodic Health Examination. The periodic health examination. Can Med Assoc J 1979;121:11931254.
28.Johnson, P, Martin, R, Burrell, L, et al.Efficacy of an alcohol/chlorhex-idine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. Med J Aust 2005;183:509514.
29.Rao, G, Jeanes, A, Osman, M, Aylott, C, Green, J. Marketing hand hygiene in hospitals—a case study. J Hosp Infect 2002;50:4247.
30.Centers for Disease Control and Prevention. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Recomm Rep 2002;51(RR-16):145.
31.World Alliance for Patient Safety, World Health Organization. WHO guidelines on hand hygiene in health care (advanced draft): a summary. Geneva: World Health Organization; 2005. Available at: http://www.who.int/patientsafety/events/05/HH_en.pdf. Accessed August 7, 2008.
32. Institute for Healthcare Improvement. How-to guide: improving hand hygiene. Available at: http://www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/Tools/HowtoGuideImprovingHandHygiene.htm. Accessed August 7, 2008.
33.Siegel, J, Rhinehart, E, Jackson, M, Chiarello, L, Healthcare Infection Control Practices Advisory Committee. Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings 2007. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf. Accessed July 8, 2008.
34.Kirkland, K, Weinstein, J. Adverse effects of contact isolation. Lancet 1999;354:11771178.
35.Saint, S, Higgins, L, Nallamothu, B, Chenoweth, C. Do physicians examine patients in contact isolation less frequently? A brief report. Am J Infect Control 2003;31:354356.
36.Evans, H, Shaffer, M, Hughes, M, et al.Contact isolation in surgical patients: a barrier to care? Surgery 2003;134:180188.
37.Catalano, G, Houston, S, Catalano, M, et al.Anxiety and depression in hospitalized patients in resistant organism isolation. South Med J 2003;96:141145.
38.Stelfox, H, Bates, D, Redelmeier, D. Safety of patients isolated for infection control. JAMA 2003;290:18991905.
39.Diekema, D, Edmond, M. Look before you leap: active surveillance for multidrug-resistant organisms. Clin Infect Dis 2007;44:11011107.
40.Scanvic, A, Denic, L, Gaillon, S, Giry, P, Andremont, A, Lucet, J. Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage. Clin Infect Dis 2001;32:13931398.
41.Hardy, K, Oppenheim, B, Gossain, S, Gao, F, Hawkey, P. A study of the relationship between environmental contamination with methicillin-resistant Staphylococcus aureus (MRSA) and patients' acquisition of MRSA. Infect Control Hosp Epidemiol 2006;27:127132.
42.Sexton, T, Clarke, P, O'Neill, E, Dillane, T, Humphreys, H. Environmental reservoirs of methicillin-resistant Staphylococcus aureus in isolation rooms: correlation with patient isolates and implications for hospital hygiene. J Hosp Infect 2006;62:187194.
43.French, G, Otter, J, Shannon, K, Adams, N, Watling, D, Parks, M. Tackling contamination of the hospital environment by methicillin-resistant Staphylococcus aureus (MRSA): a comparison between conventional terminal cleaning and hydrogen peroxide vapour decontamination. J Hosp Infect 2004;57:3137.
44.Lemmen, S, Hafner, H, Zolldann, D, Stanzel, S, Lutticken, R. Distribution of multi-resistant Gram-negative versus Gram-positive bacteria in the hospital inanimate environment. J Hosp Infect 2004;56:191197.
45.Oie, S, Hosokawa, I, Kamiya, A. Contamination of room door handles by methicillin-sensitive/methicillin-resistant Staphylococcus aureus. J Hosp Infect 2002;51:140143.
46.Rampling, A, Wiseman, S, Davis, L, et al.Evidence that hospital hygiene is important in the control of methicillin-resistant Staphylococcus aureus. J Hosp Infect 2001;49:109116.
47.de Gialluly, D, Morange, V, de Gialluly, E, Loulergue, J, van der Mee, N, Quentin, R. Blood pressure cuffs as a potential vector of pathogenic microorganisms: a prospective study in a teaching hospital. Infect Control Hosp Epidemiol 2006;27:940943.
48.Madar, R, Novakova, E, Baska, T. The role of non-critical health-care tools in the transmission of nosocomial infections. Bratisl Lek Listy 2005;106:348350.
49.Sengupta, S, Sirkar, A, Shivananda, P. Stethoscopes and nosocomial infection. Indian J Pediatr 2000;67:197199.
50.Huang, S, Datta, R, Platt, R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006;166:19451951.
51.Centers for Disease Control and Prevention. Guidelines for environmental infection control in health-care facilities: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep 2003;52(RR-10):2226.
52.Seto, W. Training the work force—models for effective education in infection control. J Hosp Infect 1995;30(Suppl):241247.
53.Lewis, A, Gammon, J, Hosein, I. The pros and cons of isolation and containment. J Hosp Infect 1999;43:1923.
54.Salgado, C, Farr, B. What proportion of hospital patients colonized with methicillin-resistant Staphylococcus aureus are identified by clinical microbiological cultures? Infect Control Hosp Epidemiol 2006;27:116121.
55.Huang, S, Rifas-Shiman, S, Warren, D, et al.Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units. J Infect Dis 2007;195:330338.
56.West, T, Guerry, C, Hiott, M, Morrow, N, Ward, K, Salgado, C. Effect of targeted surveillance for control of methicillin-resistant Staphylococcus aureus in a community hospital system. Infect Control Hosp Epidemiol 2006;27:233238.
57.Huang, S, Yokoe, D, Hinrichsen, V, 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;43:971978.
58.Safdar, N, Marx, J, Meyer, N, Maki, D. Effectiveness of preemptive barrier precautions in controlling nosocomial colonization and infection by methicillin-resistant Staphylococcus aureus in a burn unit. Am J Infect Control 2006;34:476483.
59.Lucet, J, Paoletti, X, Lolom, I, et al.Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med 2005;31:10511057.
60.Robicsek, A, Beaumont, J, Paule, S, et al.Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008;148:409418.
61.Harbarth, S, Fankhauser, C, Schrenzel, J, et al.Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA 2008;299:11491157.
62.Huskins, C. Results of the Strategies to Reduce Transmission of Anti-microbial Resistant Bacteria in Adult Intensive Care Units (STAR*ICU) Trial. In: Program and abstracts of the 17th Annual Scientific Meeting of the Society of Healthcare Epidemiology of America; April 14-17, 2007; Baltimore, MD.
63.Haley, C, Mittal, D, LaViolette, A, Jannapureddy, S, Parvez, N, Hall, D. Methicillin-resistant Staphylococcus aureus infection or colonization present at hospital admission: multivariable risk factor screening to increase efficiency of surveillance culturing. J Clin Microbiol 2007;45:30313038.
64.Manian, F, Senkel, D, Zack, J, Meyer, L. Routine screening for methicillin-resistant Staphylococcus aureus among patients newly admitted to an acute rehabilitation unit. Infect Control Hosp Epidemiol 2002;23:516519.
65.Sanford, M, Widmer, A, Bale, M, Jones, R, Wenzel, R. Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1994;19:11231128.
66.Cox, R, Conquest, C, Mallaghan, C, Marples, R. A major outbreak of methicillin-resistant Staphylococcus aureus caused by a new phage-type (EMRSA-16). J Hosp Infect 1995;29:87106.
67.Lucet, J, Chevret, S, Durand-Zaleski, I, Chastang, C, Régnier, B. Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit. Arch Intern Med 2003;163:181188.
68.Eveillard, M, de Lassence, A, Lancien, E, Barnaud, G, Ricard, J, Joly-Guillou, M. Evaluation of a strategy of screening multiple anatomical sites for methicillin-resistant Staphylococcus aureus at admission to a teaching hospital. Infect Control Hosp Epidemiol 2006;27:181184.
69.Rohr, U, Wilhelm, M, Muhr, G, Gatermann, S. Qualitative and (semi)quantitative characterization of nasal and skin methicillin-resistant Staphylococcus aureus carriage of hospitalized patients. Int J Hyg Environ Health 2004;207:5155.
70.Girou, E, Pujade, G, Legrand, P, Cizeau, F, Brun-Buisson, C. Selective screening of carriers for control of methicillin-resistant Staphylococcus aureus (MRSA) in high-risk hospital areas with a high level of endemic MRSA. Clin Infect Dis 1998;27:543550.
71.Rosenthal, A, White, D, Churilla, S, Brodie, S, Katz, K. Optimal surveillance culture sites for detection of methicillin-resistant Staphylococcus aureus in newborns. J Clin Microbiol 2006;44:42344236.
72.Safdar, N, Narans, L, Gordon, B, Maki, D. Comparison of culture screening methods for detection of nasal carriage of methicillin-resistant Staphylococcus aureus: a prospective study comparing 32 methods. J Clin Microbiol 2003;41:31633166.
73.Diederen, B, van Duijn, I, van Belkum, A, Willemse, P, van Keulen, P, Kluytmans, J. Performance of CHROMagar MRSA medium for detection of methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2005;43:19251927.
74.Diederen, B, van Leest, M, van Duijn, I, Willemse, P, van Keulen, P, Kluytmans, J. Performance of MRSA ID, a new chromogenic medium for detection of methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2006;44:586588.
75.Flayhart, D, Hindler, J, Bruckner, D, et al.Multicenter evaluation of BBL CHROMagar MRSA medium for direct detection of methicillin-resistant Staphylococcus aureus from surveillance cultures of the anterior nares. J Clin Microbiol 2005;43:55365540.
76.Stoakes, L, Reyes, R, Daniel, J, et al.Prospective comparison of a new chromogenic medium, MRSASelect, to CHROMagar MRSA and mannitol-salt medium supplemented with oxacillin or cefoxitin for detection of methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2006;44:637639.
77.Perry, J, Davies, A, Butterworth, L, Hopley, A, Nicholson, A, Gould, F. Development and evaluation of a chromogenic agar medium for methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2004;42:45194523.
78.Han, Z, Lautenbach, E, Fishman, N, Nachamkin, I. Evaluation of mannitol salt agar, CHROMagar Staph aureus, and CHROMagar MRSA for detection of methicillin-resistant Staphylococcus aureus from nasal swab specimens. J Med Microbiol 2007;56:4346.
79.Louie, L, Soares, D, Meaney, H, Vearncombe, M, Simor, A. Evaluation of a new chromogenic medium, MRSA Select, for detection of methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2006;44:45614563.
80.Nsira, S, Dupuis, M, Leclercq, R. Evaluation of MRSA Select, a new chromogenic medium for the detection of nasal carriage of methicillin-resistant Staphylococcus aureus. Int J Antimicrob Agents 2006;27:561564.
81.Smyth, R, Kahlmeter, G. Mannitol salt agar-cefoxitin combination as a screening medium for methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2005;43:37973799.
82.Huletsky, A, Lebel, P, Picard, F, et al.Identification of methicillin-resistant Staphylococcus aureus carriage in less than 1 hour during a hospital surveillance program. Clin Infect Dis 2005;40:976981.
83.Warren, D, Liao, R, Merz, L, Eveland, M, Dunne, W. Detection of methicillin-resistant Staphylococcus aureus directly from nasal swab specimens by a real-time PCR assay. J Clin Microbiol 2004;42:55785581.
84.Bishop, E, Grabsch, E, Ballard, S, et al.Concurrent analysis of nose and groin swab specimens by the IDI-MRSA PCR assay is comparable to analysis by individual specimen PCR and routine culture assays for detection of colonization by methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2006;44:29042908.
85.Drews, S, Willey, B, Kreiswirth, N, et al.Verification of the IDI-MRSA assay for detecting methicillin-resistant Staphylococcus aureus in diverse specimen types in a core clinical laboratory setting. J Clin Microbiol 2006;44:37943796.
86.Cunningham, R, Jenks, P, Northwood, J, Wallis, M, Ferguson, S, Hunt, S. Effect on MRSA transmission of rapid PCR testing of patients admitted to critical care. J Hosp Infect 2007;65:2428.
87.Bootsma, M, Diekmann, O, Bonten, M. Controlling methicillin-resistant Staphylococcus aureus: quantifying the effects of interventions and rapid diagnostic testing. Proc Natl Acad Sci U S A 2006;103:56205625.
88.Jeyaratnam, D, Whitty, C, Phillips, K, et al.Impact of rapid screening tests on acquisition of methicillin resistant Staphylococcus aureus: cluster randomized crossover trial. BMJ 2008;336:927930.
89.Bertin, M, Vinski, J, Schmitt, S, et al.Outbreak of methicillin-resistant Staphylococcus aureus colonization and infection in a neonatal intensive care unit epidemiologically linked to a healthcare worker with chronic otitis. Infect Control Hosp Epidemiol 2006;27:581585.
90.Stein, M, Navon-Venezia, S, Chmelnitsky, I, et al.An outbreak of new, nonmultidrug-resistant, methicillin-resistant Staphylococcus aureus strain (SCCmec type iiia variant-1) in the neonatal intensive care unit transmitted by a staff member. Pediatr Infect Dis J 2006;25:557559.
91.Meier, P, Carter, C, Wallace, S, Hollis, R, Pfaller, M, Herwaldt, L. A prolonged outbreak of methicillin-resistant Staphylococcus aureus in the burn unit of a tertiary medical center. Infect Control Hosp Epidemiol 1996;17:798802.
92.Wang, J, Chang, S, Ko, W, et al.A hospital-acquired outbreak of methicillin-resistant Staphylococcus aureus infection initiated by a surgeon carrier. J Hosp Infect 2001;47:104109.
93.Blok, H, Troelstra, A, Kamp-Hopmans, T, et al.Role of healthcare workers in outbreaks of methicillin-resistant Staphylococcus aureus: a 10-year evaluation from a Dutch university hospital. Infect Control Hosp Epidemiol 2003;24:679685.
94.Climo, M, Bush, A, Fraser, V, et al.Daily bathing with chlorhexidine reduces the incidence of methicillin resistant Staphylococcus aureus (MRSA), vancomycin resistant enterococci (VRE) and healthcare-associated bloodstream infections (HABSI): results of a multicenter trial. In: Program and abstracts of the 17th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; April 14-17, 2007; Baltimore, MD. Absract 297.
95.Vernon, M, Hayden, M, Trick, W, Hayes, R, Blom, D, Weinstein, R. Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce bioburden of vancomycin-resistant enterococci. Arch Intern Med 2006;166:306312.
96.Bleasdale, S, Trick, W, Gonzalez, I, Lyles, R, Hayden, M, Weinstein, R. Effectiveness of chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Intern Med 2007;167:20732079.
97.Wendt, C, Schinke, S, Wurttemberger, M, Oberdorfer, K, Bock-Hensley, O, von Baum, H. Value of whole-body washing with chlorhexidine for the eradication of methicillin-resistant Staphylococcus aureus: a randomized, placebo-controlled, double-blind clinical trial. Infect Control Hosp Epidemiol 2007;28:10361043.
98.Ridenour, G, Lampen, R, Federspiel, J, Kritchevsky, S, Wong, E, Climo, M. Selective use of intranasal mupirocin and chlorhexidine bathing and the incidence of methicillin-resistant Staphylococcus aureus colonization and infection among intensive care unit patients. Infect Control Hosp Epidemiol 2007;28:11551161.
99.Saiman, L, Cronquist, A, Wu, F, et al.An outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2003;24:317321.
100.Nambiar, S, Herwaldt, LA, Singh, N. Outbreak of invasive disease caused by methicillin-resistant Staphylococcus aureus in neonates and prevalence in the neonatal intensive care unit. Pediatr Crit Care Med 2003;4:220226.
101.Hitomi, S, Kubota, M, Mori, N, et al.Control of a methicillin-resistant Staphylococcus aureus outbreak in a neonatal intensive care unit by unselective use of nasal mupirocin ointment. J Hosp Infect 2000;46:123129.
102.Herwaldt, L. Reduction of Staphylococcus aureus nasal carriage and infection in dialysis patients. J Hosp Infect 1998;40(Suppl B):S13S23.
103.Kluytmans, JA, Mouton, JW, VandenBergh, MF, et al.Reduction of surgical-site infections in cardiothoracic surgery by elimination of nasal carriage of Staphylococcus aureus. Infect Control Hosp Epidemiol 1996;17:780785.
104.Clinical and Laboratory Standards Institute (CLSI). Analysis and presentation of cumulative antimicrobial susceptibility data. Approved guideline M39-A2. Wayne, PA: CLSI, 2006.
105.National Healthcare Safety Network (NHSN). Available at: http://www.cdc.gov/ncidod/dhqp/nhsn.html. Accessed August 7, 2008.
106.Wong, E, Rupp, M, Mermel, L, et al.Public disclosure of healthcare-associated infections: the role of the Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol 2005;26:210212.
107.McKibben, L, Horan, T, Tokars, J, et al.Guidance on public reporting of healthcare-associated infections: recommendations of the Healthcare Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 2005;26:580587.
108. The Healthcare-Associated Infection Working Group of the Joint Public Policy Committee. Essentials of public reporting of healthcare-associated infections: a tool kit. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/ar/06_107498_Essentials_Tool_Kit.pdf. Accessed July 8, 2008.
109.National Quality Forum. National voluntary consensus standards for the reporting of healthcare-associated infection data: a consensus report. Washington, DC: National Quality Forum; 2008. Available at: http://www.qualityforum.org/pdf/reports/HAI%20Report.pdf. Accessed August 7, 2008.
110.Haas, J, Larson, E. Measurement of compliance with hand hygiene. J Hosp Infect 2007;66:614.

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