Interim rules issued for VISA infections
The Centers for Disease Control and Prevention (CDC) and the Hospital Infection Control Practices Advisory Committee (HICPAC) in Atlanta have developed interim guidelines to decrease the likelihood that staphylococci with reduced vancomycin susceptibility will emerge. The guidelines also are intended to recognize occurrence, obtain information about investigational antimicrobials, and implement interim infection control measures.
The CDC and HICPAC advise each health care facility to develop a plan based on the guidelines in which responsibilities for critical departments and personnel are delineated clearly. Consult the references listed below for complete information. The following is a section of the guidelines relating to health care workers:
The following steps should be taken whenever staphylococci with reduced vancomycin susceptibility are isolated:
1. The laboratory should immediately notify infection control personnel, the clinical unit, and the attending physician.
2. Infection control personnel, in collaboration with appropriate authorities, should initiate an epidemiologic and laboratory investigation.
3. Medical and nursing staff should:
a. isolate the patient in a private room and use contact precautions (gown, mask, gloves, and antibacterial soap for handwashing) as recommended for multidrug-resistant organisms2;
b. minimize the number of persons with access to colonized/infected patients;
c. dedicate specific health care workers to provide one-on-one care for the colonized/infected patient or the cohort of colonized/infected patients.
4. Infection control personnel should:
a. inform all personnel providing direct patient care of the epidemiologic implications of such strains and of the infection control precautions necessary for their containment;
b. monitor and strictly enforce compliance with contact precautions and other recommended infection control practices;
c. determine whether transmission already has occurred by obtaining baseline cultures (before initiation of precautions) for staphylococci with reduced susceptibility to vancomycin from the anterior nares and hands of all health care workers, roommates, and others with direct patient contact;
d. assess efficacy of precautions by monitoring health care workers for acquisition of staphylococci with reduced susceptibility to vancomycin as recommended by consultants from the CDC or state health department;
e. avoid transferring infected patients within or between facilities, and if transfer is necessary, fully inform the receiving institution or unit of the patient’s colonization/infection status and appropriate precautions;
f. consult with the CDC and state health department before discharging colonized/infected patients.
References
1. Centers for Disease Control and Prevention. Interim guidelines for prevention and control of staphylococcal infection associated with reduced susceptibility to vancomycin. MMWR 1997; 46:626-8, 635-6.
2. Garner JS. Hospital Infection Control Practices Advisory Committee. Guidelines for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996; 17:53-80.
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