d. Infection Control 

Prevention and control of infections caused by MDRO pathogens require knowledge of known critical infection pathways (Livermore 2003), elucidated by surveillance and coupled with application of appropriate contact and environmental controls, as well as antimicrobial stewardship principles for appropriate antibiotic use. 

Since 1996, the CDC has recommended the use of standard and contact precautions for MDROs. Hand hygiene is an important component of this. There is a demonstrated temporal relationship between improved adherence to recommended hand hygiene practices and control of MDROs. In a recent article, Goldman emphasized that infections such as MRSA are transmitted primarily by the contaminated hands of healthcare providers who have touched a colonized patient or something in the patient's environment (Goldmann 2006). It is estimated that 30% to 40% of endemic institutional antibiotic resistance is caused by ineffective or absent hand washing (Jarvis 1994). 

In the absence of ASC data, a patient’s MDRO colonization status is frequently unknown. Therefore, standard precautions must be used in order to prevent transmission from potentially colonized patients. In situations where an MDRO outbreak has been detected, or for patients at high risk for MDRO colonization, more aggressive contact precautions should be implemented (Smith et al. 2008). Even in facilities that use contact precautions for patients with an identified MDRO, standard precautions play an important role in infection control (Cooper et al. 2004). Patients may remain colonized with MDROs for prolonged periods. Shedding of these organisms may be intermittent and surveillance cultures may fail to detect their presence. The duration of contact precautions following successful treatment of MDRO pathogen infections for patients who remain colonized at one or more body sites remains an unresolved issue.