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:

* Inclusion criteria will include all HCA hospitals that reside in US states where physicians do NOT routinely prescribe decolonization for MRSA + ICU patients.

Exclusion Criteria:

* Exclusion criteria will include hospitals where ICU physicians often prescribe decolonization for MRSA+ ICU patients.
* Dedicated burn ICUs will also be excluded due to the inability to perform routine bathing.
* Finally, since the intent is to assess the intervention in adult ICUs, pediatric hospitals will be excluded although patients \<13 years old that are admitted to participating adult ICUs will be included in the unit-based intervention.
B: Inclusion Criteria:

* Data collection will be compiled from all the participants admitted to the Medical Intensive Care Unit (MICU).
* For skin cultures: One randomly selected (intubated or non-intubated) patient in each intervention group

Exclusion Criteria:

* Patients with greater than 20% of body surface area disruption in skin integrity will be excluded from participation in the 2% CHG Antiseptic Cloths arm of the study
C: 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
D: Inclusion Criteria:

* Age \> 18 years
* Admission in critical care unit eg. ICU, respiratory care unit, Cardiac care unit with in 24 hours
* Expected duration of critical care unit admission \> 48 hours

Exclusion Criteria:

* History of chlorhexidine allergy

Answer: C