Strategies for prevention and control of multiple drug-resistant nosocomial infection.

Multiple drug-resistant bacteria are common in the hospital and are often isolated from patients on admission. Spread in hospital and occasional epidemics result from transient contamination of the personnel's hands, environmental contamination and excessive use of antibiotics. Traditional control measures have relied on improved asepsis and handwashing, isolation (or cohorting) of infected and colonized patients, antibiotic control and elimination of any significant environmental sources. Newer approaches have focused on ways of preventing (or eliminating) patient carriage of multiple drug-resistant strains. We have tailored selected barrier-type "antibiotic resistance precautions" for everyday use to control endemic aminoglycoside resistant gram-negative bacilli. We detail our multifaceted approach and suggest its ongoing use for key multiple drug-resistant strains, in "epi-centers," such as intensive care units, for potential heavy shedders of multiple drug-resistant strains, and when certain epidemic thresholds are reached.