Resident Grand Rounds

Nick Powers

May 9, 2007

MRSA/VRE: Do I Really Have to Wear a Gown?

1. MRSA and VRE infections are both significant causes of patient morbidity and mortality, especially in ICUs, nationwide
2. Risk factors for colonization and infection with multi-drug resistant organisms (MDROs) are organism specific; however, the following patient characteristics are universal risk factors: indwelling catheters, patient immobility, frequent hospitalizations, and burns.
3. Indiscriminate use of continued broad spectrum antibiotics leads to colonization pressure for patients to carry and become infected with MDROs.
4. Colonization with MDROs DOES lead to increased likelihood of subsequent infections with respective organisms increasing morbidity, duration of hospitalization, and treatment costs.
5. Not all MRSA is created equal…there is emerging genetic evidence that certain MRSA strains harbor additional virulence factors that increase morbidity and mortality greater than even standard MRSA strains.
6. HAND WASHING…JUST DO IT!! It is THE CHEAPEST and one of the MOST EFFECTIVE precautions to limit spread of MDROs. Among healthcare workers, physicians are among the least compliant with this measure.
7. Active surveillance cultures and subsequent patient isolation of MDRO colonized patients are effective ways to reduce transmission and infection, especially in ICU settings.
8. Patients colonized with MDROs may harbor the organisms for up to 40 months.
9. Selected high risk patients may undergo decolonization attempts and benefit in terms of reduced infectious risk, but these benefits are often transient and require repeating to establish documented MDRO eradication.