Treatment-resistant microbial germs have become a major public health problem.

Microorganisms that are resistant to various forms of treatment cause most nosocomial infections. More and more, microbial germs are found not only in hospitals but also in the community at large among people who have had no contact with the clinical environment.

Researchers now know that multi-resistant germs are the result of genetic mutation. Once a resistant form of a germ finds its way into a hospital unit, it becomes more virulent and spreads quickly throughout the establishment. Although ICU's are particularly high-risk environments, resistant germs are becoming more widespread in other units as well.

Health care professionals most frequently talk about methicillin-resistant Staphlycoccus aureus (MRSA), and Clostridum difficile (C. difficile), but many other germs are now resistant to treatment and regularly cause outbreaks  of nosocomial infections. Among these bacteria are Streptococcus, Klebsiella, enterococcus, Pseudomonas aeroginosa, Escherichia coli (E. coli) and Acinetobacter baumanii. Furthermore, several viruses are also treatment-resistant. In 1990, only one percent of enterococcus strains were resistant to vancomycin but this has now risen to 28%. In 1990, twenty percent of Staphylococcus aureus strains were antibiotic resistant, but by 2003 the level had increased to 60% in some countries. MRSA's have increased greatly among the general public in the USA and this specific strain has now spread to Europe as well as several other countries.

The complexity and the ever-increasing number of treatment techniques have resulted in more frequent patient transfers within hospitals. Consequently, infected and colonized patients spread resistant strains throughout the establishment. The same situation occurs when moving patients from one hospital to another. Ambulance transfers facilitate the spread of germs. Similarly, the increasing number of colonized patients transferred by airplane allows germs to spread to other regions and countries in a matter of hours.

The only way to effectively contain the spread of these infections is to establish a rigorous surveillance policy that involves workers at every level of the health care system; from front-line workers such as orderlies, nurses, and doctors to administrators and decision makers. It is imperative to involve patients, their families, and the general public. This new approach requires a complete change of culture in the health care system. Over the last thirty years the ever-increasing number and seriousness of treatment-related nosocomial infections is undermining medical advances made over the past century. For example, the development of antibiotics to treat infections was one a major medical discovery in the twentieth century, but antibiotic resistant strains negate advances made in infection control.

In conclusion, safe medical treatment is the most important indicator of the quality of medical care, and must be made the top priority of public health policy.