Experience applying the UK meticillin-resistant Staphylococcus aureus (MRSA) guidelines in a tertiary referral hospital in the United Arab Emirates 1999-2002: same guidelines, different cultures.

Meticillin-resistant Staphylococcus aureus (MRSA) is an important nosocomial pathogen worldwide. There are few reports concerning MRSA in the United Arab Emirates (UAE). We report our experience with MRSA in a 400-bed tertiary referral hospital in the UAE, which followed the UK MRSA guidelines. MRSA data were reviewed to include demographic and clinical data on all new MRSA cases; a review of the ward environment including number of single rooms, sinks, toilets and bathrooms, frequency of cleaning; cultural observations; and number of infection control personnel per beds. MRSA was an uncommon pathogen. There were 90 new MRSA cases from 1999 to 2002 including two clusters of MRSA. While the procedures followed were the same as those in the UK, there were differences in the hospital environment compared with the UK and in cultural aspects of the patients' behaviour. At least 70% of inpatients were in single rooms with ensuite bathrooms. It was rare for more than two patients to share a toilet or bathroom. There were fewer than recommended infection control personnel and no antibiotic restriction policy in the hospital. Cleaners were on the wards for >100 h per week and were available 24 h per day for rapid response. We conclude that there are many factors that influence the management and control of MRSA, including cultural and social behaviour.

Guidelines for the control of glycopeptide-resistant enterococci in hospitals.

The increase since the mid 1980s in glycopeptide resistant enterococci (GRE) raised concerns about the limited options for antimicrobial therapy, the implications for ever-increasing numbers of immunocompromised hospitalised patients, and fuelled fears, now realised, for the transfer of glycopeptide resistance to more pathogenic bacteria, such as Staphylococcus aureus. These issues underlined the need for guidelines for the emergence and control of GRE in the hospital setting. This Hospital Infection Society (HIS) and Infection Control Nurses Association (ICNA) working party report reviews the literature relating to GRE prevention and control. It provides guidance on microbiological investigation, treatment and management, including antimicrobial prescribing and infection control measures. Evidence identified to support recommendations has been categorized. A risk assessment approach is recommended and areas for research and development identified.

Infection control. A long time coming.

This article presents the case of a doctor who developed multidrug-resistant tuberculosis in his right lung. Development of the disease was attributed to treatment errors and resulted in surgical intervention to effect a cure. The isolation and management of this patient spanned a total of 12 months. Infection control interventions to minimise the effects of sensory deprivation, given the length of stay of the patient, appear to have been satisfactory, with no treatment for any clinical depression required. The availability of negative pressure ventilation and the then controversial use of masks prevented any nosocomial transmission of MDR TB. Use of masks resulted in a two-tier system of infection control. It was difficult to make such a decision in the absence of any published UK guidelines. Guidelines have subsequently been published.