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Thanks to Michael Bennett for his comment and link to the 2003 SHEA Guidelines for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of Staphylococcus aureus and Enterococcus. The Guidelines present a scholarly look at Antibiotic-resistant pathogens and their important and growing threat to the public health.

The Guidelines recognize that infectious diseases are in aggregate the leading cause of human death worldwide and the third leading cause of human death in the United States. More than 70% of the bacteria that cause hospital-acquired infections are resistant to at least one of the drugs most commonly used to treat these infections.

The Guidelines make recommendations in nine critical areas:

  • I. Surveillance Cultures to Identify the Reservoir for Spread
  • II. Proper Hand Hygiene
  • III. Barrier Precautions for Patients Known or Suspected to Be Colonized or Infected With Epidemiologically Important Antibiotic-Resistant Pathogens Such as MRSA or VRE
  • IV. Antibiotic Stewardship
  • V. Decolonization or Suppression of Colonized Patients
  • VI. Education Programs
  • VII. Adequate Methods of Disinfecting
  • VIII. Computer Alerts for Colonized Patients
  • IX. Dedicated Noncritical Patient-Care Equipment

Where these recommendations have been implemented, the incidence of MRSA infections has shown a drastic fall. In Denmark, the prevalence of MRSA blood isolated reached a peak of 33% in the 1960’s, but declined steadily after introduction of a policy to control transmission, and has been maintained at less than 1% for 25 years. In Finland and the Netherlands, the prevalence of MRSA has been maintained at lower that 0.5%.

Why is it that hospitals in the United Stated have been unable to achieve these results? After all, we are the richest country in the world. It is well past time for our hospitals to implement these measures and take their heads out of the sand.

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