Public Release:  Control of antibiotic-resistant bacteria in out-patient clinics and offices

Part of a CMAJ series on antimicrobial resistance

Canadian Medical Association Journal

While infections with antibiotic-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile (C.difficile) and vancomycin-resistant Enterococcus, are usually associated with in-patient settings, the potential for infection in out-patient clinics and offices exists. A review in CMAJ outlines infection control strategies for these settings to help minimize transmission of these potentially deadly pathogens.

"The recent emergence of community-associated MRSA, vancomycin-resistant Enterococcus and C.difficile among patients with no known predisposing factors has increased the potential for offices and clinics to become silent reservoirs of these pathogens," write Dr. Anne Matlow and coauthor from the Hospital for Sick Children (SickKids) and the University of Toronto.

Hygiene, education and cleaning of physical environments are important for infection control. Careful prescribing of antibiotics is also key.

Health care workers are the main mode of transmission and should be the primary target of prevention strategies which include hand washing with alcohol-based hand rubs or soap and water - the most essential part of infection control. Additional precautions, such as gown and gloves, should be used in caring for patients with diarrhea, cystic fibrosis or draining wounds.

A multipronged approach, including policies and guidelines for identifying and managing infected patients, access to personal protective equipment and hand sanitizers or soap and water is required to prevent transmission.

"Since most cases of transmission in ambulatory care are a result of deficient infection-control practices, strict adherence to recommendations is paramount," write the authors.

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