H ealth care-associated infections, associated with antibiotic resistance, lead to considerable morbidity, mortality, and costs. Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) are the primary causes of these infections and are associated with worse outcomes than infections caused by antibiotic-susceptible S. aureus and Enterococcus. Although current interventions to prevent such infections focus on hand hygiene, compliance rates remain low. The use of gloves and gowns, however, may reduce the acquisition of antibiotic-susceptible and antibiotic-resistant bacteria by health care workers and decrease transmission to patients. This clusterrandomized trial was conducted to assess whether wearing gloves and gowns for all contact with intensive care unit (ICU) patients compared with the use of contract precautions only would reduce acquisition rates of MRSA and VRE infections.The study was conducted in 20 medical and surgical ICUs in 20 US hospitals during 2012. In the intervention group (10 ICUs), health care workers wore gloves and gowns for all patient contact and when entering any patient room. The control group workers (10 ICUs) wore gloves and gowns according to the Centers for Disease Control guidelines for patients with known antibioticresistant bacteria. In 2011, ICU staff collected baseline data on the primary outcome of MRSA or VRE acquisition. The ICUs were then pair matched based on baseline MRSA or VRE acquisition rates as a composite outcome. The primary outcome was acquisition of either MRSA or VRE as a composite based on results of ICU admission and discharge surveillance cultures for MRSA and VRE. Secondary outcomes were MRSA and VRE acquisition as 2 separate outcomes, frequency of health care worker visits, hand hygiene compliance, health care-associated infections, and adverse events. Analyses of all outcomes were conducted at the ICU level, followed the intention-to-treat approach, and accounted for the matched-pair design.During the baseline and study periods, 6324 and 19,856 patients were admitted to ICUs, respectively, and 20,646 and 71,595 swabs, respectively, were collected for detection of MRSA and VRE. Compliance with wearing gloves in the intervention ICUs was 86.18% (2787/3234), and compliance with gowns was 85.14% (2750/3230). In the control group, 10.52% of patients were on contact precautions, and for these patients, compliance with staff wearing gloves and gowns was 84.11% (556/661) and 81.21% (536/660), respectively. The intervention ICUs had a decrease in the primary outcome from 21.35 acquisitions per 1000 patient-days (95% confidence interval [CI], in the baseline period to 16.92 acquisitions per 1000 patientdays (95% CI, 14.09-20.28) in the study period. Control ICUs had a decrease from 19.02 acquisitions per 1000 patient-days (95% CI, 14.20-25.49 acquisitions) in the baseline period to 16.29 acquisitions per 1000 patient-days (95% CI,) in the study period. This difference in changes was not statistically significant (difference, −1....

BACKGROUND. Antibiograms have effectively improved antibiotic prescribing in acute-care settings; however, their effectiveness in skilled nursing facilities (SNFs) is currently unknown.

Overview of the 100,000 Lives Campaign "The names of the patients whose lives we save can never be known. Our contribution will be what did not happen to them. And, though they are unknown, we will know that mothers and fathers are at graduations and weddings they would have missed, and that grandchildren will know grandparents they might never have known, and holidays will be taken, and work completed, and books read, and symphonies heard, and gardens tended that, without our work, would never have been."

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This article describes the role of the hospital environment in the spread of pathogens by direct and indirect contact. In addition, the prevention of transmission through interventions involving the built environment is discussed. BACKGROUND: The hospital environment can become contaminated with pathogenic microorganisms, some of which can persist for long periods of time. Although contamination is common, the contribution of the hospital environment to the development of healthcare-associated infections remains unclear. In part spurred by the development of newer technologies to enhance environmental cleaning or to prevent contamination, research into the role of the environment in causing healthcareassociated infections has accelerated. TOPICAL HEADINGS: A review of the recent literature finds an increasing body of evidence implicating contaminated surfaces in patient care areas in the transmission of pathogens and the development of infections. Single-patient rooms and optimally placed alcohol hand rub dispensers and other design features can mitigate infection risk. Enhanced environmental cleaning including touchless technologies and self-cleaning surfaces can reduce environmental contamination and may prevent infections. CONCLUSIONS: The hospital environment contributes to transmission of pathogens in hospitals and to the development of healthcare-associated infections. Newer technologies to prevent environmental contamination or to enhance cleaning are promising although additional studies with the endpoints of reduction of infections are needed before the role of these technologies is known.