Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Novel Approach to MRSA Screening of Colonized Patients and Impact on Hospital Resource Allocation and Patient Care
Brief Summary: Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in hospital settings. Colonization with MRSA puts patients at increased risk for invasive infections, and MRSA infections have been associated with high costs and adverse clinic outcomes. Patients can clear MRSA spontaneously. Improved approaches for identifying patients who are no longer colonized are needed; we hypothesize that more sensitive nucleic acid amplification can be used to improve identification of patients who are no longer colonized.


Options:
A: 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.
B: Inclusion Criteria:

* Internal medicine interns, residents, and hospitalists working on acute medicine ward service.

Exclusion Criteria:

* Not willing/unable to participate in study
* Not working a full 8 hour day in the hospital
C: 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
D: 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

Answer: D