infection control & hospital epidemiology october 2015, vol. 36, no. 10 original article
Reconsidering Contact Precautions for Endemic Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus
Daniel J. Morgan, MD, MS;1 Rekha Murthy, MD;2 L. Silvia Munoz-Price, MD, PhD;3 Marsha Barnden, RNC, MSN, CIC;4 Bernard C. Camins, MD, MSc;5 B. Lynn Johnston, MD, MSc;6 Zachary Rubin, MD;7 Kaede V. Sullivan, MD;8 Andi L. Shane, MD, MPH, MSc;9 E. Patchen Dellinger, MD;10 Mark E. Rupp, MD;11 Gonzalo Bearman, MD, MPH12
background. Whether contact precautions (CP) are required to control the endemic transmission of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) in acute care hospitals is controversial in light of improvements in hand hygiene, MRSA decolonization, environmental cleaning and disinfection, fomite elimination, and chlorhexidine bathing.
objective. To provide a framework for decision making around use of CP for endemic MRSA and VRE based on a summary of evidence related to use of CP, including impact on patients and patient care processes, and current practices in use of CP for MRSA and VRE in US hospitals.
design. A literature review, a survey of Society for Healthcare Epidemiology of America Research Network members on use of CP, and a detailed examination of the experience of a convenience sample of hospitals not using CP for MRSA or VRE.
participants. Hospital epidemiologists and infection prevention experts.
results. No high quality data support or reject use of CP for endemic MRSA or VRE. Our survey found more than 90% of responding hospitals currently use CP for MRSA and VRE, but approximately 60% are interested in using CP in a different manner. More than 30 US hospitals do not use CP for control of endemic MRSA or VRE.
conclusions. Higher quality research on the benefits and harms of CP in the control of endemic MRSA and VRE is needed. Until more definitive data are available, the use of CP for endemic MRSA or VRE in acute care hospitals should be guided by local needs and resources.
Infect. Control Hosp. Epidemiol. 2015;36(10):1163–1172
Despite decades of experience, the use of contact precautions (CP) for endemic methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) remains controversial.1,2 As a result, there is a growing diver- sity of practice for CP in acute care hospitals.1,3 A North American group of adult and pediatric hospital epidemiolo- gists and infection prevention experts with expertise in guideline development met on the Society for Healthcare Epidemiology of America (SHEA) Guidelines committee and, independent of SHEA or SHEA endorsement, completed this article to elucidate the current state of the literature pertaining to the application and discontinuation of CP for endemic MRSA and VRE. In addition, the group administered a survey to the SHEA Research Network of hospital epidemiologists and infection preventionists to better ascertain the practice and
experience with CP for endemic MRSA and VRE. Finally, a convenience sample of hospitals that do not use CP for MRSA or VRE was identified from the literature and an infection control listserv, and their experiences were elicited and summarized.
methods
Guidelines were reviewed for recommendations relating to use of CP for endemic MRSA or VRE. A literature search for English language publications from 2003 through 2013 was conducted on PubMed using the search terms “CP,”“barrier precautions,”“isolation,”“MRSA,” and “VRE” to identify papers that compared the use of CP with some other standard for the control of MRSA and VRE in endemic settings.
Affiliations: 1. University of Maryland, Baltimore, Maryland; 2. Cedars-Sinai Medical Center, Los Angeles, California; 3. Medical College of Wisconsin,
Milwaukee, Wisconsin; 4. Adventist Health System, Roseville, California; 5. University of Alabama at Birmingham, Birmingham, Alabama; 6. Dalhousie University, Halifax, Nova Scotia; 7. David Geffen School of Medicine at UCLA, Los Angeles, California; 8. Clinical Microbiology Laboratory, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; 9. Emory University School of Medicine, Atlanta, Georgia; 10. Department of Surgery, University of Washington Medical Center, Seattle, Washington; 11. University of Nebraska Medical Center, Omaha, Nebraska; 12. Medical College of Virginia, Richmond, Virginia.
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2015/3610-0006. DOI: 10.1017/ice.2015.156 Received February 24, 2015; accepted June 5, 2015; electronically published July 3, 2015
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