The article by Edmond and colleagues [1] on control of emergent vancomycin-resistant S. aureus is contrary to experience with the epidemiology and transmission of methicillin-resistant S. aureus. Little evidence supports airborne or fomite transmission of methicillin-resistant S. aureus. Acquired traits of antimicrobial resistance in bacteria have not been shown to alter virulence or transmission to the degree that could be inferred from the recommendations of Edmond and colleagues.

We advocate the use of broad universal precautions for all patients: hand washing before and after all patient contact; use of gloves for all contact with body fluids and secretions, mucous membranes, and nonintact skin; use of gowns if soiling is likely to occur; and use of masks and protective eye wear if splashing of body fluids is likely [2]. Use of broad universal precautions has many advantages, including 1) ease of implementation, 2) application of a single standard of care, 3) no reliance on identification of colonized or infected patients, 4) no reliance on routine culturing, 5) no need to flag charts for readmission, and 6) no need to isolate patients or staff. The use of broad universal precautions also protects workers from exposure to blood-borne pathogens.

We agree with Edmond and colleagues that hands are the major mode of transmission of methicillin-resistant S. aureus. Therefore, hand washing technique and compliance should be stressed. Use of mupirocin for eradicating nasal carriage of methicillin-resistant S. aureus has been shown to be effective in the short term. However, resistance and recolonization occur, limiting the usefulness of this agent to outbreaks. Cleaning of rooms with standard hospital-approved disinfectants eradicates resistant bacteria, but environmental cultures are costly, unnecessary, and contrary to recommendations of the Centers for Disease Control and Prevention. Specimen processing is unnecessary [3].

Efforts to control use of vancomycin should be the major focus of prevention strategies. Overuse of antimicrobial agents has consistently been shown to result in resistant organisms [4, 5]. Efforts should be focused on such measures of proven efficacy as hand washing and use of antibiotics.