The role of an isolation unit in the control of hospital infection with methicillin-resistant staphylococci

Bacteriological characters of strains ofStaphylococcus aureussubmitted to a reference laboratory related to methicillin resistance

“…The delayed emergence of first gentamicin-resistant strains, and then, very quickly, of methicillin and gentamicinresistant strains was unexpected. In recent times apparent epidemics have been recorded in Newcastle (Selkon, Stokes & Ingham, 1980), Ireland (Cafferkey et al 1983), Liverpool and, most well-documented in our sources, the London regions.…”

Quarantine, Isolation, and Cohorting: From Cholera toKlebsiella

“…Doctor Barrett predicted that ''methicillin-resistant staphylococci will become more widespread in the United States and may present some clinical and epidemiologic problems in the future'' [19]. This forecast was correct: The following four decades were replete with instances of MRSA outbreaks in the community, hospital wards, nursing facilities, and, ubiquitously, medical, surgical, and neonatal intensive care units (ICUs) [15,[20][21][22][23][24][25][26][27]. The 1980s saw the arrival of MDROs expressing resistance to progressively newer antibiotics.…”

“…However, as discussed previously, hospitals constantly at capacity or with limited ICU availability may not have the ability to do this [50]. In 1973, a 1,000-bed hospital converted a standard ward into an isolation unit, complete with individual washroom facilities and a central exhaust system to control ventilation [21]. Ten years later, a large Veterans Affairs medical center controlled a large MRSA outbreak with an isolated ward staffed with a dedicated medical team [22].…”

“…Nearly ubiquitous to all outbreaks is the initial failure of standard isolation precautions, universal screening of new admissions, and the cohorting of nursing, ancillary staff, and patient care equipment [21,26,30,31,33,34,41,[45][46][47]50]. Other methods of outbreak control are unit closure [21,30,[42][43][44]48], hiring of additional staff or an infectious disease consultant [22,44], encouraging use of disposable equipment [42], and screening of staff and subsequent reassignment of those colonized to non-clinical duties [15,30,48].…”

“…This has proved effective for disrupting outbreaks of MRSA [21,22,26,27], VRE [38,39,[41][42][43], ESBL-producing K. pneumoniae [30,[32][33][34], S. marcescens [44], Acinetobacter baumannii [31,[45][46][47], and P. aeruginosa [48].…”