Skip to main content Accessibility help

Routine Use of Contact Precautions for Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus: Which Way Is the Pendulum Swinging?

  • Dana Russell (a1), Susan E. Beekmann (a2), Philip M. Polgreen (a2), Zachary Rubin (a3) and Daniel Z. Uslan (a3)...



Studies have suggested that contact precautions (CP) for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus may have risks that outweigh the benefits. These risks, coupled with more widespread use of horizontal interventions such as daily bathing with chlorhexidine gluconate, have brought into question the value of routine CP for these organisms.


To assess the state of utilization of CP as well as adjunctive measures to reduce the risk of transmission in US hospitals.


Cross-sectional survey.


Total of 751 physician members of the Emerging Infections Network.


An 8-question electronic survey distributed by email.


A total of 426/751 (57%) responded to the survey; 337/364 (93%) of respondents use routine CP for methicillin-resistant S. aureus and 335/364 (92%) use routine CP for vancomycin-resistant enterococcus. The most widely used trigger for initiation of CP for both pathogens was positive clinical culture. Practices for discontinuation of isolation varied widely. We found that 325/354 (92%) perform routine chlorhexidine gluconate bathing and 236/353 (67%) perform S. aureus decolonization with mupirocin for 1 or more subsets of inpatients, and 82/356 (23%) reported using either hydrogen peroxide vapor or ultraviolet-C room disinfection at discharge. Free text responses noted frustration and variation in the application, practice, and process for initiation and discontinuation of CP.


Use of CP for methicillin-resistant S. aureus and vancomycin-resistant enterococcus remains commonplace, although horizontal interventions such as chlorhexidine gluconate bathing are increasingly used. The heterogeneity of practices and policies was striking. Evidence-based guidelines regarding CP and horizontal interventions are needed.

Infect. Control Hosp. Epidemiol. 2015;37(1):36–40


Corresponding author

Address correspondence to Daniel Z. Uslan, MD, MS, FIDSA, FSHEA, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, 37-121 CHS, Los Angeles, CA 90095 (


Hide All

Presented in part: IDWeek 2014; Philadelphia, Pennsylvania; October 8–12, 2014, abstract #6820.



Hide All
1. Siegel, JD, Rhinehart, E, Jackson, M, et al. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35:S65S164.
2. Climo, MW, Yokoe, DS, Warren, DK, et al. Effect of daily chlorhexidine bathing on hospital-acquired infection. N Engl J Med 2013;368:533542.
3. Hayden, MK, Bonten, MJ, Blom, DW, et al. Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis 2006;42:15521560.
4. Barnes, SL, Morgan, DJ, Harris, AD, et al. Preventing the transmission of multidrug-resistant organisms: modeling the relative importance of hand hygiene and environmental cleaning interventions. Infect Control Hosp Epidemiol 2014;35:11561162.
5. Nerandzic, M, Thota, P, Sankar, CT, et al. Evaluation of a pulsed xenon ultraviolet disinfection system for reduction of healthcare-associated pathogens in hospital rooms. Infect Control Hosp Epidemiol 2015;36:192197.
6. Gandra, S, Barysauskas, CM, Mack, DA, et al. Impact of contact precautions on falls, pressure ulcers and transmission of MRSA and VRE in hospitalized patients. J Hosp Infect 2014;88:170176.
7. Karki, S, Leder, K, Cheng, AC. Patients under contact precautions have an increased risk of injuries and medication errors: a retrospective cohort study. Infect Control Hosp Epidemiol 2013;34:11181120.
8. Day, HR, Perencevich, EN, Harris, AD, et al. Depression, anxiety, and moods of hospitalized patients under contact precautions. Infect Control Hosp Epidemiol 2013;34:251258.
9. Dashiell Earp, CN, Bell, DS, Ang, AO, et al. Do physicians spend less time with patients in contact isolation? A time-motion study of internal medicine interns. JAMA Intern Med 2014;174:814815.
10. Morgan, DJ, Pineles, L, Shardell, M, et al. The effect of contact precautions on healthcare worker activity in acute care hospitals. Infect Control Hosp Epidemiol 2013;34:6973.
11. Shenoy, ES, Walensky, RP, Lee, H, et al. Resource burden associated with contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: the patient access managers’ perspective. Infect Control Hosp Epidemiol 2012;33:849852.
12. Mehrotra, P, Croft, L, Day, HR, et al. Effects of contact precautions on patient perception of care and satisfaction: a prospective cohort study. Infect Control Hosp Epidemiol 2013;34:10871093.
13. Dhar, S, Marchaim, D, Tansek, R, et al. Contact precautions: more is not necessarily better. Infect Control Hosp Epidemiol 2014;35:213221.
14. Morgan, DJ, Murthy, R, Munoz-Price, LS, et al. Reconsidering contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus . Infect Control Hosp Epidemiol 2015;36:11631172.
15. Martin, EM, Russell, D, Rubin, Z, Uslan, DZ. The impact of discontinuing routine contact precautions for endemic MRSA and VRE on healthcare associated infection rates and costs. In: Program and abstracts of IDWeek 2014; Philadelphia, PA; October 8-12, 2014, abstract #6820.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed