Hospital Infection Control Strategies for Vancomycin-resistant Enterococcus, Methicillin-Resistant Staphylococcus aureus and Clostridium difficile.

Antimicrobial resistance is an increasing problem and challenge worldwide. Methicillin-resistant Staphylococcus aureus (MRSA) is the most commonly identified antimicrobial-resistant pathogen in areas of the world where these data are available. Rates of MRSA among clinical isolates of S. aureus vary from less than 1% in Norway and Sweden, 5%–10% in Canada, 25%–50% in the United States, to more than 50% in Hong Kong and Singapore. In a multinational survey of nosocomial pathogens, none of the clinical enterococcal isolates from South Africa, Egypt, Saudi Arabia or Lebanon were vancomycin-resistant enterococci. However, 7% of isolates from Germany and 16.7% of isolates from Switzerland and Greece were vancomycin-resistant enterococci. Resistance among these pathogens is much more prevalent among nosocomial infections than among community-acquired infections. The hypervirulent strain of Clostridium difficile, identified as a cause of outbreaks in North America, has been detected in an increasing number of European countries, affecting hospitals in 11 European Union member states and Switzerland. Four key hospital interventions – hand hygiene, environmental cleaning, barrier precautions and screening – are the cornerstones of infection control. In this article, the researchers review the current knowledge and best practices in these areas. CMAJ. 2009;180(6):627-31.