Advisory Group:

Paula Blankenship, R.N., C.I.C.
Kathy Butler, R.N., C.I.C.
Joyce Frederick, R.N.C., M.S.N., C.I.C.
Polly Godwin, R.N.
Donna Goering, M.T. (A.S.C.P.), M.S.P.H., C.I.C.
Wanda Lamm, R.N., B.S.N., C.I.C.
Linda Lemmons, R.N.
Susan Liles, R.N., C.I.C.
Jean-Marie Maillard, M.D., M.Sc.
Joyce Reddington, R.N.
William A. Rutala, Ph.D., M.P.H., C.I.C.
Stephen Streed, M.S., C.I.C.
Sharon Thompson, R.N., C.I.C.
David J. Weber, M.D., M.P.H.
Douglas Williams, M.T. (A.S.C.P.), C.I.C.

In collaboration with:

North Carolina Department of Environment, Health and Natural Resources
General Communicable Disease Control Section
J. Newton MacCormack, M.D., M.P.H., Chief

A special acknowledgement to Eva Clontz for editorial review and revision.

The guidelines are in three separate sections on the World Wide Web.

First Section: Title page, Note to Users on the Web, Contents

Second Section: The text of the guidelines (Scroll to the end of this section. At the end of the Contents, click "The Guidelines.")

Third Section: Attachments

These guidelines outline the recommendations from the North Carolina General Communicable Disease Control Section and the Statewide Infection Control Program for all healthcare facilities and outpatient settings regarding managing VRE and MRSA. The guidelines are not regulatory but will provide consistency as patients move from one healthcare setting to another in North Carolina. Recently as reports of multiply-antibiotic-resistant organisms have been increasing, there have been many requests from facilities for statewide recommendations.

You may copy this document freely without obtaining permission from the authors, but please do give credit to the authors. Printed copies are NOT available from the office of the Statewide Infection Control Program. Consultation and assistance about these guidelines are available only to healthcare facilities in North Carolina.

  I. Introduction

 II. Background

     A. Methicillin-Resistant Staphylococcus aureus (MRSA)

     B. Vancomycin-Resistant Enterococci (VRE)

III. Colonization vs. Infection

     A. Colonization

        1. MRSA

        2. Enterococci

     B. Infection

 IV. Epidemiology

     A. Methicillin-Resistant Staphylococcus aureus

        1. Mode of Transmission

        2. Reservoirs

        3. Risk Factors

     B. Vancomycin-Resistant Enterococci

        1. Mode of Transmission

        2. Reservoirs of VRE

        3. Risk Factors

  V. Control Measures

     A. General Control Measures

        1. Infection Control Plan

        2. Handwashing

        3. Communication

        4. Standard Precautions

        5. Decolonization Therapy

        6. Education

        7. Visitors

        8. Surveillance

     B. Institutionally Specific Control Measures

        1. Acute Care Facilities

        2. Long Term Care Facilities

        3. Home Health Care/Hospice

        4. Doctors' Offices/Outpatient Clinics

        5. Schools for the Physically and Mentally
           Challenged

        6. Rest Homes/Retirement Centers

        7. Rehabilitation Hospitals

        8. Psychiatric Hospitals

        9. Patients Discharged to Their Homes


Centers for Disease Control and Prevention: HICPAC Guidelines

   Attachment A: Prudent Vancomycin Use (See Recommendations 
        for Preventing the Spread of Vancomycin Resistance

   Attachment B: Standard Precautions (See Part II. 
        Recommendations for Isolation Precautions 
        in Hospitals - "Standard Precautions")

   Attachment C: Prevention and Control of Nosocomial Transmission of VRE 
        (See Recommendations for Preventing
        the Spread of Vancomycin Resistance - 
        "Prevention and Control of VRE")

   Attachment D: Contact Precautions (See Part II. 
        Recommendations for Isolation Precautions in 
        Hospitals - "V. Contact Precautions")


References

To UNC-CH Home Page

Created 23 May 1997. Last modified: 28 July 1998