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Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006

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Table 1. Categorization of Reports about Control of MDROs in Healthcare Settings, 1982- 2005

MDRO MDR-GNB MRSA VRE
No. of Studies Reviewed/category 30 35 39
Types of Healthcare Facilities from which Study or Report Arose
No. (%) from academic facilitiesα 30 (100) 28 (80) 33 (85)
No. (%) from other hospitals 0 4 (11) 3 (85)
No. (%) from LTCFs 0 1 (3) 2 (5)
No. (%) from multiple facilities in a region 0 2 (6) 1 (2)
Unit of Study for MDRO Control Efforts
Special unitβ 20 13 19
Hospital 10 19 17
LTCF 0 1 2
Region 0 2 1
Nature of Study or Report on MDRO Controlχ
Outbreak 22 19 28
Non-outbreak 8 16 11
Total Period of Observation after Interventions Introduced
Less than 1 year 17 14 25
1-2 Years 6 6 6
2-5 Years 5 11 8
Greater than 5 years 2 4  
Numbers of Control Measures Employed in Outbreaks/Studies
Range 2-12 0-11 1-12
Median 7 7 8
Mode 8 7 9

α Variably described as university hospitals, medical school affiliated hospitals, VA teaching hospitals, and, to a much lesser extent, community teaching hospitals
β Includes intensive care units, burn units, dialysis units, hematology/oncology units, neonatal units, neonatal intensive care units, and, in a few instances, individual wards of a hospital
χ Based on authors' description – if they called their experience an outbreak or not; authors vary in use of term so there is probable overlap between two categories

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Table 2. Control Measures for MDROs Employed in Studies Performed in Healthcare Settings, 1982-2005

Focus of MDRO (No. of Studies) MDR-GNB (n=30) MRSA (n=35) VRE (n=39)
 
No. (%) of Studies Using Control Measure
Education of staff, patients or visitors 19 (63) 11 (31) 20 (53)
Emphasis on handwashing 16 (53) 21 (60) 9 (23)
Use of antiseptics for handwashing 8 (30) 12 (36) 16 (41)
Contact Precautions or glove useα 20 (67) 27 (77) 34 (87)
Private Rooms 4 (15) 10 (28) 10 (27)
Segregation of cases 4 (15) 3 (9) 5 (14)
Cohorting of Patients 11 (37) 12 (34) 14 (36)
Cohorting of Staff 2 (7) 6 (17) 9 (23)
Change in Antimicrobial Use 12 (41) 1 (3) 17 (44)
Surveillance cultures of patients 19 (63) 34 (97) 36 (92)
Surveillance cultures of staff 9 (31) 8 (23) 7 (19)
Environmental cultures 15 (50) 14 (42) 15 (38)
Extra cleaning & disinfection 11 (37) 7 (21) 20 (51)
Dedicated Equipment 5 (17) 0 12 (32)
Decolonization 3 (10) 25 (71) 4 (11)
Ward closure to new admission or to all patients 6 (21) 4 (12) 5 (14)
Other miscellaneous measures 6 (22) β 9 (27) χ 17 (44) δ

α Contact Precautions mentioned specifically, use of gloves with gowns or aprons mentioned, barrier precautions, strict isolation, all included under this heading
β includes signage, record flagging, unannounced inspections, selective decontamination, and peer compliance monitoring (1 to 4 studies employing any of these measures)
χ includes requirements for masks, signage, record tracking, alerts, early discharge, and preventive isolation of new admissions pending results of screening cultures (1 to 4 studies employing any of these measures)
δ includes computer flags, signage, requirement for mask, one-to-one nursing, changing type of thermometer used, and change in rounding sequence (1 to 7 studies employing any of these measures)

References for Tables 1 and 2

MDR-GNBs: (6, 8, 9, 11, 16, 38, 174, 175, 180, 209, 210, 213-215, 218, 334, 388, 406, 407)
MRSA: (68, 89, 152, 153, 165-173, 183, 188, 194, 204, 205, 208, 240, 269, 279, 280, 289, 304,
312, 327, 365, 392, 397, 408-412)

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