This is a 15-month multicenter study to determine if rates of colonization and infection with 2 resistant Gram-positive bacteria - methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant Enterococcus (VRE) - among patients in adult intensive care units (ICUs) are lower in ICUs that use an intensive infection control strategy plus standard care compared to ICUs that use standard care alone. The intensive control strategy involves: (1) identifying patients who are colonized with MRSA or VRE by the use of prospective surveillance cultures of the anterior nares (for MRSA) and stool or perianal area (for VRE); (2) Universal Gloving until the patients are discharged or their surveillance culture results show they are not colonized with MRSA or VRE; and (3) Contact Precautions during care of patients who are colonized with MRSA or VRE. Twenty ICU sites distributed throughout the US will be enrolled in the study. Surveillance cultures for the intensive control populations will be collected on all patients at the time of admission to the ICU, weekly during their ICU stay, and at the time of discharged. All specimens (approximately 180,000) will be processed in the Clinical Center Microbiology Labs. Specimens will be screened for MRSA or VRE using an enrichment broth technique and selective agar culture methods, and the resistance genes will be detected by PCR. Preliminary work has been performed developing the enrichment and selective culture methods. All positive specimens and isolates of MRSA and VRE will be stored at -80 C for future studies. Studies that have already been designed include: comparison of direct analysis of specimens for MRSA or VRE by PCR with the conventional culture method; assessment of the prevalence of vancomycin-intermediate and vancomycin-resistant S. aureus; assessment of the prevalence of vancomycin-dependent Enterococcus; epidemiologic clonality of MRSA and VRE isolates for the 20 study sites.
