[Prevention of transmission of multidrug-resistant bacteria]

The increase in multidrug-resistant bacteria (MDR) is a worldwide problem. Depending on the type of pathogen there are only a few and less effective treatment options available; therefore, effective infection prevention is of major importance.

Which infection prevention and control measures are effective and feasible for the prevention of MDR transmission?

Discussion and critical appraisal of current recommendations and the available literature.

Studies evaluating infection control measures for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci and multidrug-resistant Gram-negative bacteria differ with respect to the prevalence of MDR, screening methods, number of available personnel and compliance with hand hygiene measures. Many databases result from outbreak investigations and are not comparable with the endemic setting. In addition, the bundle approach makes it impossible to evaluate a single measure alone.

The guidelines and recommendations for dealing with colonized and infected patients are of low evidential value and often difficult to implement in the clinical practice. The single most important measure to avoid transmission is still disinfection of the hands. Single room isolation and contact precautions are often recommended but the relevance is unclear; however, the disadvantages of patients being isolated are well studied and of major concern. Screening measures have to be adapted to the local situation. Full body washing of all patients in at-risk areas with chlorhexidine appears to be an attractive and effective alternative to screening and isolation.