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Reconsidering Contact Precautions for Endemic Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus

Published online by Cambridge University Press:  03 July 2015

Daniel J. Morgan*
Affiliation:
University of Maryland, Baltimore, Maryland
Rekha Murthy
Affiliation:
Cedars-Sinai Medical Center, Los Angeles, California
L. Silvia Munoz-Price
Affiliation:
Medical College of Wisconsin, Milwaukee, Wisconsin
Marsha Barnden
Affiliation:
Adventist Health System, Roseville, California
Bernard C. Camins
Affiliation:
University of Alabama at Birmingham, Birmingham, Alabama
B. Lynn Johnston
Affiliation:
Dalhousie University, Halifax, Nova Scotia
Zachary Rubin
Affiliation:
David Geffen School of Medicine at UCLA, Los Angeles, California
Kaede V. Sullivan
Affiliation:
Clinical Microbiology Laboratory, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Andi L. Shane
Affiliation:
Emory University School of Medicine, Atlanta, Georgia
E. Patchen Dellinger
Affiliation:
Department of Surgery, University of Washington Medical Center, Seattle, Washington
Mark E. Rupp
Affiliation:
University of Nebraska Medical Center, Omaha, Nebraska
Gonzalo Bearman
Affiliation:
Medical College of Virginia, Richmond, Virginia
*
Address correspondence to Daniel J. Morgan, MD, MS, 685 W. Baltimore St, MSTF 334, University of Maryland, Baltimore, MD 21201 (dmorgan@epi.umaryland.edu).

Abstract

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

Type
Original Articles
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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