Guidelines Offer Ways To Curb Antibiotic-Resistant Infections

May 13, 1997

CHAPEL HILL -- Infections caused by organisms that no longer respond to antibiotics are increasing alarmingly fast in hospitals and health care facilities across the nation, University of North Carolina at Chapel Hill experts say. The most common infection, “Staph aureus,” now resists treatment by antibiotics in 29 percent of cases, up from about 2 percent in 1975.

Responding to the growing health concern, the N.C. Statewide Infection Control Program at the UNC-CH School of Medicine has prepared guidelines for preventing and controlling the spread of two of the most prevalent antibiotic-resistant infections. Program staff worked with others at the N.C. Communicable Disease Section on the project.

Designed to be easy to read, the eighteen-page document is titled, “North Carolina Guidelines for Control of Antibiotic-Resistant Organisms, Specifically Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococci (VRE).”

“These organisms, MRSA and VRE, present an ever-growing problem,” said Karen Hoffmann, co-author of the guidelines and a clinical instructor at the medical school. “The guidelines offer practices designed to reduce transmission between patients.”

Recently, the U.S. Centers for Disease Control and Prevention (CDC) published rigorous “Isolation-Precaution” guidelines for hospitals, Hoffmann said, but the new N.C. statewide measures target facilities such as nursing homes and doctors' offices.

“The approach we took is very reasonable,” Hoffmann said. “It wouldn't make any sense, for example, to treat a patient at home the same way the CDC recommends treating a patient in intensive care. But until now, that was all anybody had to go by -- the CDC guidelines.”

Hoffmann and co-author Irene Kittrell, an infection control practitioner at UNC Hospitals, identified nine health-care settings needing control measures. They are long-term care, home health, hospices, doctors' offices and outpatient clinics, schools for the physically and mentally challenged, rest homes and retirement centers, rehabilitation hospitals, psychiatric hospitals and patients discharged directly to their homes. The new guidelines address each area separately.

“We deal with many issues, including roommate selection, hand washing, gowning, gloving and transporting patients,” Hoffmann said. “The state guidelines provide a consistency of care that was never in place before.”

Twenty-one other states have guidelines, but North Carolina's are the most up-to-date, she said.

“We're sending copies to all the health-care associations, hoping they will distribute them.”

The guidelines are not laws, but regulatory agencies that survey and license health facilities will use them to determine if care is being provided appropriately, Hoffmann said. All health-care settings in the state need a copy.

Begun in 1980, the N.C. Statewide Infection Control Program is funded by the state and offers consulting services to N.C. hospitals and other health-care facilities and educational programs. The staff also include Drs. William Rutala, director, and Dr. David Weber, both professors at the School of Medicine, and Eva Clontz, program coordinator.

University of North Carolina at Chapel Hill

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