Edmond and colleagues [1] gave their perspectives on the measures necessary to control transmission of vancomycin-resistant S. aureus. Most of the measures they suggest are not new and are similar to measures recommended by the Hospital Infection Control Practices Advisory Committee for preventing the spread of vancomycin-resistant enterococci [2]. However, they did suggest some measures that are unique and may be difficult to follow. They stated that a monitor could be placed at the door of a patient infected or colonized with vancomycin-resistant S. aureus. This monitor would prevent unauthorized access and enforce hand washing and barrier precautions. This measure may be difficult to implement: Given the climate of cost containment in most hospitals, a request for an extra person to perform even an important task may be perceived by administration as affecting the bottom line. Despite the epidemic of vancomycin-resistant enterococci at our institution, physicians' and nurses' compliance with hand washing between contact with different patients and before and after changing of dressings, manipulation of central lines, and invasive procedures has remained poor (Table 1). Nurses have generally been more compliant than physicians. Notably, only 11% of observed physicians washed their hands after removing gloves.

Closing a unit to new admissions when a nosocomial transmission is documented is also important for preventing transmission of resistant organisms. However, this precaution may be difficult to achieve when a hospital is already full.

Edmond and colleagues suggest postponing diagnostic and therapeutic procedures for patients infected or colonized with vancomycin-resistant S. aureus. Because antimicrobial agents for treatment of this infection are limited, drainage and debridement of abscesses and wounds may be the only therapeutic options that can be offered to these patients.

Compliance with infection-control measures would greatly improve if vancomycin-resistant S. aureus that was contracted by health care workers resulted in a fatal disease. If a hospital were to have an outbreak of infection with the Ebola virus, the compliance rate for infection-control measures would soar. All patients deserve the best possible medical care, which includes simple efforts to prevent the spread of resistant organisms to patients who are not already colonized.