Infection control programs have repeatedly demonstrated efficacy in reducing infection rates and in controlling the spread of MDR organisms. Unfortunately, staff compliance with proven infection control measures, such as hand disinfection, is often poor and inconsistent. Staff education aimed at infection control must be inclusive, frequent, and reiterative. Special attention must be directed to house staff, students, volunteers, and visitors who may not be included in regularly scheduled infection control educational programs.
Surveillance of ICU infections to identify and quantify endemic and new MDR organisms with data feedback is a critical. Communication of current data among clinicians, laboratory, pharmacy, and infection control staff is essential. Organism-specific strategies for specific MDR pathogens are recommended. For MRSA, vancomycin-resistant S aureus, or glycopeptide-resistant S aureus isolates, more aggressive screening, and isolation are recommended, and more aggressive eradication has been advocated. Antibiotic control programs are also extremely important in the overall effort to control infections, reduce emergence of MDR organisms, and control spiraling health-care costs. For example, reduced use of fluoroquinolones has been associated with reduced rates of MRSA infection. Antibiotic control strategies are complicated, and should be focused, dynamic, carefully monitored, and may vary by type of MDR pathogen. For example, control of specific types of MDR Gram-negative bacilli, may require “squeezing the balloon at multiple sites” to prevent the emergence of other MDR pathogens, as nicely summarized Rahal and coworkers. In addition, an infectious disease pharmacist for the ICU team or computerized surveillance programs to target interventions and aid in determining optimal drug regimens should be considered. Data from antibiotic rotation programs are more difficult to evaluate, but this approach has been advocated for reducing MDR pathogens. Most cases of VAP, particularly those caused by resistant bacteria, are the result of pathogenic microorganisms in the host and environment. Although it is widely appreciated that the hospital environment is swarming with microorganisms, this does not necessarily translate into nosocomial infections and widespread routine environmental sampling is not recommended. Studies- are beginning to implicate the inanimate environment as an indirect contributor to nosocomial acquisition of some potential pathogens. Special interventions, including targeted environmental sampling and more aggressive environmental disinfection, may be indicated during nosocomial outbreaks, particularly those involving MDR organisms or organisms that are more resistant to routine cleaning. Legionella species can be recovered from 12 to 70% of hospital water systems and this source of nosocomial outbreaks remains underappreciated.