table 1a. Literature Review of Articles From 2004 to 2013 That Examined the Effect of CP (With or Without Other Measures) on MRSA Interventions used
Lead author Trick et al8
Lucet et al14 Huang et al13
Robicsek et al15 Harbarth et al9 Bearman et al34
Trial design RCT
Before-after Quasi-
experimental Before-after
Cross-over quasi- experimental
Before-after
Huskins et al12 RCT Jain et al17
Derde et al68 Harris et al16
Marshall et al10
RCT RCT
Before-after Before-after
Hospital-wide √√ √ –– √ Surgical patients √√ √ –– √ –
ICUs √ – ICUs √√ √ –– – Setting Gowns Gloves
Surveillance Culturing HH
Universal decolonization SNFs √√ –– – Targeted
decolonization Main findings –
ICUs √√ √ –– – ICUs √√ √ –– –
UG use was equivalent to CP in SNFs that did not limit patient activities Surveillance cultures to guide CP led to a decrease in MRSA acquisition rates
Surveillance cultures to guide CP decreased MRSA acquisition rates and BSI rates; same decrease in BSI rates observed hospital-wide
Surveillance cultures to guide CP and targeted colonization resulted in a decrease in invasive MRSA infection rates
Surveillance cultures to guide CP and targeted decolonization did not reduce nosocomial MRSA infection rates with endemic MRSA prevalence
√ –– UG use was equivalent to CP for prevention of MRSA acquisition
Surveillance cultures to guide CP vs standard CP alone resulted in equivalent MRSA acquisition or infection rates
ICUs √√ √ √
Hospital-wide √√ √ √ –– Bundle of surveillance cultures to guide CP, HH, and institutional culture change was associated with a decrease in MRSA colonization and infection rates No impact of surveillance cultures to guide CP
√ √
ICUs √√ √ –– – ICUs √√ √ –– –
Universal CP use significantly reduced MRSA acquisition Surveillance cultures to guide CP resulted in a decrease in MRSA acquisition rates
NOTE. BSI, bloodstream infection; CP, contact precautions; HH, hand hygiene; ICU, intensive care unit; MRSA, methicillin-resistant Staphylococcus aureus; RCT, randomized controlled trial; SNF, skilled nursing facility; UG, universal gloving.
table 1b. Literature Review of Articles From 2004 to 2013 That Examined the Effect of CP (With or Without Other Measures) on VRE Interventions used
Lead author Bearman et al6 Trial design Setting Gowns Gloves
Surveillance cultures HH
Before-after MICU Before √√ √
Bearman et al34 Before-after SICU Before √√ √ ICU √√ √ √
Huskins et al12 RCT of 18 ICUs
Harris et al16 Derde et al11
RCT of 20 ICUs
Before-after ICU √√ √ √ Universal
decolonization No
No No
ICUs √√ –– – √
decolonization Main findings No
Targeted
No difference in VRE acquisition risk between CP and UG use
No No –
No
No difference in VRE acquisition risk between CP and UG use
No impact of surveillance culturing and isolation for MDROs
Universal CP use had no effect on VRE acquisition but was associated with less MRSA acquisition
No impact of surveillance culturing and isolation for MDROs
NOTE. CP, contact precautions; HH, hand hygiene; ICU, intensive care unit; MDRO, multidrug-resistant organism; MICU, medical intensive care unit; MRSA, methicillin-resistant Staphylococcus aureus; RCT, randomized controlled trial; SICU, surgical intensive care unit; UG, universal gloving; VRE, vancomycin-resistant Enterococcus.
reconsidering contact precautions for endemic 1165
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