Please select the eligibility criteria that correspond to the clinical trial below.
Title: Mastering Hospital Antibiotic Resistance, a Cluster Randomized Intervention Study in Intensive Care Units Throughout Europe (Work Package 3)
Brief Summary: Colonization of patients with Antimicrobial Resistant Bacteria (AMRB) like Methicillin Resistant Staphylococcus Aureus (MRSA), Vancomycin-Resistant Enterococcus (VRE) and Extended-Spectrum Beta-Lactamases (ESBL) enterobacteriaceae leads to infections; and ultimately to adverse outcomes (eg prolonged hospital stay, death). This is an urgent problem in Europe, especially in Intensive Care Units (ICUs).

In this trial, colonization of patients with these AMRB will be assessed in the baseline period (6m). In phase 2 the effect of a Hygiene Improvement Program, including Chlorhexidine body washings and a Hand Hygiene training program, will be assessed (6m). In phase 3 units will be randomized to either Active Surveillance with Chromagar based tests or a Molecular based tests.

Study Hypothesis: the abovementioned interventions will reduce ICU-acquired colonization rates with MRSA, VRE and ESBL.


Options:
A: Inclusion Criteria:

* colonization with either MRSA, VRE or ESBL is endemic
* at least one dedicated infection control physician
* ability to obtain, store and analyze surveillance cultures
* at least 8 ICU beds; all of which have possibility for mechanical ventilation
* ability to collect the data required for analysis
* written approval of the institution's IRB
* signed protocol signature page

Exclusion Criteria:

* burn units
* cardiothoracic units
* pediatric and neonatal ICUs
* ICU is currently using rapid diagnostic testing in their screening program for AMRB
* ICU is planning to enroll subjects in studies testing investigational agents for the purpose of eradicating or preventing colonization with MRSA, VRE or ESBL or devices or practice management strategies that have colonization and/or infection with AMRB as an outcome
* using SOD/ SDD or any topical antimicrobial therapy
* using chlorhexidine body washings
B: Inclusion Criteria:

* age \> 18
* last positive MRSA culture greater than 3 months old
* admitted to hospital

Exclusion Criteria:

* age \< 18
* last positive MRSA culture less than or equal to 3 months old
C: Inclusion Criteria:

ICUs that meet all of the following criteria are eligible to participate in the study:

1. Adult medical, surgical, or medical/surgical ICU, meeting the following descriptions:

   Medical ICU-\>=80% of patients have medical conditions and have not undergone a surgical procedure during their hospital stay (patients weaned from mechanical ventilation may be included); Surgical ICU-\>=80% of patients have undergone a surgical procedure during their hospital stay (thoracic, cardiovascular, abdominal, orthopedic, neurosurgical, transplant, urologic, and trauma surgery procedures may be included); and Medical/surgical ICU-a roughly equivalent mixture of patients with medical conditions who have not undergone surgical procedures and patients who have undergone surgical procedures during their hospitalization (i.e., each group constitutes more than 20% and less than 80% of the total number of patients).
2. Patient volume of \>=1200 patient days/6 months or \>=2400 patient days/12 months during 2002, 2003, or 2004;
3. Incidence density of colonization of \>=9 colonization events with either MRSA or VRE/1000 ICU patient days based on results of clinical cultures during 2002, 2003, or 2004;
4. Ability to collect the data required for the analysis;
5. Written approval of the study from the institution's IRB; and
6. Signed protocol signature page indicating willingness to enroll ICU in the study from the ICU physician and the ICU nursing directors.

Exclusion Criteria:

Intensive care units that meet any of the following criteria are excluded from the study:

1. Coronary care, burn, bone marrow/hematopoetic stem cell transplant, neurosurgical, pediatric, or neonatal ICUs;
2. ICUs currently screening all patients for colonization with MRSA and VRE on admission to the ICU and at least once a week during their ICU stay with results of surveillance cultures reported to clinicians (Note: ICUs screening only selected, "high-risk" patients, screening patients on admission to the ICU but not an ongoing basis, or screening patients for MRSA or VRE but not both MRSA and VRE are not excluded);
3. ICUs currently with a policy for Universal Gloving for all patient contact regardless of whether the patient is known to be colonized with VRE or MRSA;
4. ICUs planning to enroll subjects in studies testing investigational agents administered for the purpose of eradicating or preventing colonization with MRSA or VRE or devices or practice management strategies that have colonization and/or infection with resistant organisms as an outcome.
D: Inclusion Criteria:

* Clinical diagnosis of Acute Myocardial Infarction (AMI) from 12/1/03 to 5/31/04
* Beta-blocker dispensing following AMI
* Beta-blocker dispensing prior to intervention date

Exclusion Criteria:

None

Answer: A