reconsidering contact precautions for endemic 1167 Although a number of studies have investigated the rela-
tionship between CP and patient satisfaction, patient percep- tions about the quality of care varied.58,59 In medical and surgical inpatient wards, Mehotra et al58 found that patients on CP were more likely to have concerns with their care than patients who were not on CP (odds ratio, 2.0 [95% CI, 1.3–3.2]). In contrast, Gasink et al59 administered the Consumer Assessment of Healthcare Providers and Systems Hospital Survey to medical and surgical inpatients exposed and unexposed to CP and reported that CP was not associated with less satisfaction. In conclusion, CP consistently appears to modify HCP
behavior, leading to fewer patient contacts. Multiple types of harm have been described with CP in the literature but results have been inconsistent and study quality has been relatively low.
Proportion of Patients on CP for MRSA or VRE
CP is applied to a substantial proportion of hospitalized patients and varies by geographical area and the methods used to identify MRSA or VRE. If samples obtained during routine clinical care are the basis for identifying MRSA or VRE, an estimated 5%–10% of patients in US acute-care facilities are isolated compared with 20%–25% of patients when surveil- lance testing for MRSA or VRE is used to identify coloniza- tion.12,16,17,60–62 Because patients on CP have longer lengths of
hospital stay, the proportion of patients on CP on a ward can be as high as 60%.61
Survey of SHEA Members/SHEA Research Network on Use of CP
The SHEA Research Network is an international consortium of more than 200 hospitals conducting multicenter research projects in healthcare epidemiology. A total of 87 members of the SHEA Research Network responded to the survey regarding their institutions’ use of CP for MRSA and VRE (response rate, 33% [87/267]). Table 2 summarizes respondent perceptions and attitudes toward CP. Most respondents worked at acute care hospitals (93%) and belonged to teaching or teaching-affiliated hospitals (72%). Ninety-two percent of respondents reported using CP in their respective facilities for both MRSA and VRE. Respondents applied CP for positive surveillance screens (nasal, axillary, or perineal screen) for MRSA (48%) and VRE (49%), diarrhea (71%), uncontrolled secretions (44%), and uncovered wounds (27%). Cohorting of MRSA- or VRE-colonized patients in double occupancy rooms was either never done (46%) or performed only in extreme cases of bed shortage (43%). Most respondents (63%) were in favor of implementing CP in a different fashion than current practice (Figure 1), and most felt that CP decreased the number of HCP visits to patients (78%) and had a negative impact on mental
table 2. Results of SHEA Research Network Survey of Respondents’ Beliefs Relating to CP Extent to which HCP believe CP prevents
MRSA VRE
Ways in which HCP believe CP causes harm Decrease in number of visits
Negative impact on patient’s mental health Negative impact on patient’s satisfaction
Increase in adverse events (eg, falls or pressure ulcers)a HCP opinion of CP Physicians
Nurses Others
Beliefs regarding routine use of surveillance culturing and CP for MRSA and VRE Routine surveillance culturing and CP helpful in ICUs
Targeted surveillance culturing and CP helpful in wards or high-risk population Surveillance culturing and CP useful during outbreaks Surveillance culturing and CP not helpful
Have a large impact Have a slight impact Have no Impact 31 (41%)
27 (36%)
58 (78%) 46 (68%) 50 (69%) 26 (38%)
Dislike
61 (94%) 48 (76%) 52 (87%)
24% 18% 32% 21%
NOTE. CP, contact precautions; HCP, healthcare personnel; ICU, intensive care unit; MRSA, methicillin-resistant Staphylococcus aureus; SHEA,
Society for Healthcare Epidemiology of America; VRE, vancomycin-resistant Enterococcus. aAdditional responses: decrease 16 (24%), no impact 26 (38%).
Like
3 (5%) 9 (4%) 4 (7%)
36 (47%) 38 (51%)
9 (12%) 9 (14%)
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