Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus: recognition and prevention in intensive care units.

Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) have achieved significant rates of colonization and infection in most intensive care units (ICUs). Both pathogens share common epidemiologic characteristics that suggest similar surveillance and control strategies. MRSA and VRE are readily found on colonized patients and their environment; healthcare workers' hands are a major vector of patient-to-patient transmission. Generally accepted strategies for control include conducting a baseline risk assessment and establishing metrics for monitoring MRSA and VRE rates in ICUs; promoting hand hygiene compliance; guaranteeing adequate staffing levels; ensuring adequate environmental cleaning; and using "bundled" interventions to decrease site-specific ICU infections (e.g., central venous catheter-associated bloodstream infections). During periods of inadequate control, special strategies are available, although no consensus exists over which combination of these interventions is most effective. Some special interventions are pathogen specific (targeted), such as active surveillance and decolonization. Others are pathogen nonspecific (global), such as daily chlorhexidine bathing of all patients in the ICU. We review the evidence for these interventions to help ICU personnel better control MRSA and VRE in their units.