Please select the eligibility criteria that correspond to the clinical trial below.
Title: Cluster Randomized Trial of Hospitals to Assess Impact of Targeted Versus Universal
Brief Summary: The Randomized Evaluation of Decolonization versus Universal Clearance to Eliminate MRSA (REDUCE MRSA) Trial is a cluster randomized trial of the comparative effectiveness of three strategies to prevent methicillin-resistant Staphylococcus aureus (MRSA) in intensive care units. The three strategies to be evaluated are:

* screening on admission followed by isolation of MRSA+ patients
* screening on admission followed by isolation and decolonization of MRSA+ patients
* universal decolonization on admission with no screening. The decolonization regimen involves bathing with chlorhexidine plus intra-nasal application of mupirocin. The main outcome will be MRSA+ clinical cultures.

The study is a partnership between the CDC, the CDC Prevention Epicenters, and the Hospital Corporation of America.


Options:
A: Inclusion Criteria:

* Adults over 18 years
* Expected length of stay \> 48h in intensive care unit
* Informed written consent

Exclusion Criteria:

* Cerebral death
* Care limitation
* Neutropenia
* Documented MRSA on admission
* Patients receiving antistaphylococcal topical antibiotics on admission
B: 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.
C: Inclusion Criteria:

* Treatment with invasive mechanical ventilation
* Feeding via nasogastric tube within 36 hours after the initiation of endotracheal mechanical ventilation.
* Age over 18 years
* Informed consent

Exclusion Criteria:

* Mechanical ventilation started more than 36 hours before institution of enteral feeding
* Patients turned in the prone position at inclusion
* Abdominal surgery within 1 month before inclusion
* History of esophageal or gastric surgery
* EN via a gastrostomy or a jejunostomy
* Bleeding from esophagus, stomach or bowel
* Moribund patient
* Age less than 18 years
* Pregnancy.
* No informed consent.
D: Inclusion Criteria:

* mechanical ventilation (only invasive ventilation: i.e. intubated patients or patients with tracheostomal ventilation)
* no planned extubation within 24 hours When mechanical ventilation is not started directly after admission but later in the course of their ICU stay, patients are still eligible to participate.

Exclusion Criteria:

* patients under the age of 18
* patients with known allergy to any of the medications or agents used (i.e. colistin, tobramycin, nystatin or chlorhexidine )
* pregnancy

Participation ends as soon as the patient is extubated or after tracheostomal ventilation has stopped (weaning completed).

Answer: B