Antibiotic resistance in hospitals and intensive care units: The problem and potential solutions

Antimicrobial resistance has generally increased over the past 5 decades, with occasional brief respites following the introduction of new antimicrobial classes. Resistance has been driven by bacterial genetic events, antibiotic pressures, and lapses in hospital hygiene. Recently promoted solutions to the problem of hand hygiene include use of alcohol-based hand rubs, which are time savers and gentler to hands than soap and water, and use of "universal gloving." The most effective antibiotic interventions have been restriction programs and provider computer-order entry. Unabated antimicrobial resistance requires use of surveillance cultures and contact precautions or cohort nursing for all patients colonized or infected by resistant strains.