Researchers found environmental reservoirs of<unk>  bacteria in ICU sinks and drains. Despite multiple attempts to sterilize these sinks and drains, using detergents and steam, the hospital staff was unsuccessful in getting rid of the<unk> . Due to the bacterial resistance to cleaning measures, staff should take extreme precaution in maintaining sterile environments in hospitals not yet infected with the<unk> -resistant bacteria. A major means of transmission is through sinks, so staff should take extra precaution in maintaining sterile conditions. Hospitals could reduce transmission by<unk> ating sinks with designs that could reduce backsplash. Another method to reduce transmission from sink to sink is to have sink brushes in each room that would be for cleaning that individual sink alone. Hospital staff should be trained to never dispose of clinical waste down the sinks in patient rooms. A hospital in Melbourne, Australia, implemented similar strategies as these to reduce transmission and prevent further infection of more ICU patients. Armed with the knowledge of their status as<unk>  transmission sites, hospitals must take special care to monitor<unk>  outbreaks within their wards. Efficient and accurate detection of<unk>  is the first step.<unk>  are most commonly found in the intestinal flora. Using stool and rectal swabs are, thus, the most reliable methods for testing resistance. No billing code exists for<unk>  under Medicare or Medicaid, making it difficult to track on a national level in the U.S. Another challenge facing efforts to control transmission is the fact that although long-term care facilities have been heavily indicated as the primary centers for incidence, amplification, and spread of<unk> , studies that have controlled for this transmission have still found<unk>  spreading in other affiliated hospitals, indicating that long-term acute-care facilities are likely not the sole culprit in the spread of<unk>  and other multidrug-resistant organisms. One method found effective is to screen and isolate incoming patients from other facilities, and renew focus on hand washing. No new drugs for the bacteria are in development and the bacteria's rapid adaptation to new drugs makes investment in their development unprofitable, as the new drug would quickly become useless. Studies have found that<unk>  incidence and prevalence can be reduced by applying targeted interventions including increased hygiene measures and equipment sterilization, even in populations where the prevalence of infection exceeds 50% of patients. However, additional environmental cleaning to control transmission has not been verified by controlled trials. The involvement of local and national public health authorities will likely be critical to ensure broader and more sustainable implementation of these measures. Prevention is a top priority for reducing person-to-person transmission of<unk> . This is especially true because limited treatment options are available to use after<unk>  resistance develops. Most current research calls for a coordinated, multifaceted approach to infection prevention and containment, and the Centers for Disease Control and Prevention have issued preliminary guidelines for the control of<unk>  transmission. Experts advocate for a proactive approach, based on the belief that it will be most cost-effective to combat the problem before it is established. However, when immediate financial and personnel resources are limited, healthcare administrators may be forced to respond reactively, aiming to reduce any further transmission. Although a consensus exists for the need of prevention protocols, infection control practices often vary among hospitals, even within close geographic area. In a survey of 15 hospitals within the Toronto area, many hospitals employed varying combinations of basic infection control practices. Eight different practices were observed among the 15 hospitals, some of which included in the most recent publication of guidelines from the Public Health Agency of Canada. Some of these recommendations include laboratory testing, active surveillance, screening (rectal swab, urine culture), hand hygiene, personal protective equipment, environmental cleaning, laundry waste management, and isolation with dedicated equipment and nursing staff. However, only five hospitals had written policies describing how to respond to an outbreak. Many public health initiatives are moving towards a more standardized approach at multiple levels: among local facilities (especially long-term and acute care), regional hospitals, national institutions, and global practices. A standardized approach of prevention may help to more effectively reduce the emergence of<unk> . An infection control plan was implemented at the Kaplan Medical Center in Israel to control a hospital outbreak of<unk> -resistant K. pneumoniae. The comprehensive plan included guidelines for cohorting patients in separate locations, cleaning with 1,000 ppm hypochlorite, screening for isolates from rectal swabs, and distribution of educational instruction sheets, lectures for all medical staff, and training. The hospital also implemented an automated computer system that updated patient charts when new cases were reported, if patients were carriers, and what precautions to take when dealing with such patients. This plan was evaluated in a quasiexperimental study through the incidence of clinical cases, the rate of cross-infection, and the rate of screening for carriage in admitted patients with increased risk of carriage. The study had a 16-fold decrease in the incidence of resistant K. pneumoniae, which was sustained for 30 months. The plan can provide a model for other hospitals to contain outbreaks of<unk> -resistant bacteria. A reduction in the use of unnecessary invasive devices, including urinary catheters, could help reduce<unk>  transmission. Several methods have been tested for their effectiveness at improving thorough intensive-care unit environmental hygiene. A study conducted in 2010 across 3532 high risk environmental surfaces in 260 intensive care unit rooms in 27 acute-care hospitals (ICUs) assessed the consistency at which these surfaces met base line cleaning standards. Only 49.5% of the high-risk object surfaces were found to meet this baseline criterion. The least-cleaned objects were bathroom light switches, room door knobs, and bed pan cleaners. Significant improvements in ICU room cleaning was achieved through a structured approach that incorporated a simple, highly objective surface targeting method and repeated performance feedback to environmental surface personnel. Specific methods included implementing an objective evaluation process, environmental surfaces staff education, programmatic feedback, and continuous training to minimize the spread of hospital-associated infections. The authors noted an improvement in the thoroughness of cleaning at 71% from baseline for the entire group of hospitals involved.
Carbapenem-resistant enterobacteriaceae
Vancomycin-resistant Enterococcus
Shigatoxigenic and verotoxigenic Escherichia coli
Vancomycin-resistant Staphylococcus aureus
Methicillin-resistant Staphylococcus aureus
Rapid growing mycobacterium
Isolated levocardia
Enteroinvasive Escherichia coli