Infection control measures to limit antimicrobial resistance.

Increasing antimicrobial resistance has resulted in a rapidly decreasing array of therapeutic options for infections in the critical care setting. Reports of reduced susceptibility to vancomycin in Staphylococcus aureus raise the possibility of patients being infected with a virulent pathogen for which 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 infections, adequate hand hygiene, isolation of patients who harbor resistant organisms, and the use of barrier techniques such as gowns and gloves. Surveillance using clinical isolates alone is inadequate for the identification of the majority of patients who carry resistant organisms. However, it is unclear what intensity of surveillance is needed to control the spread of these organisms in the intensive care unit in nonoutbreak situations. Attempts at eradicating carriage are often unsuccessful when there is extranasal colonization with methicillin-resistant S. aureus. Transmission of resistant organisms is primarily the result of transient contamination of healthcare workers' hands. Adequate handwashing, isolation of carriers, and barrier techniques are all necessary for containing resistance within the intensive care unit, however, compliance with these measures can be compromised by high staff turnover and heavy workload.