Hostname: page-component-848d4c4894-2xdlg Total loading time: 0 Render date: 2024-07-01T03:47:23.507Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  21 October 2015

Dana Russell ,
Susan E. Beekmann ,
Philip M. Polgreen ,
Zachary Rubin  and
Daniel Z. Uslan
Dana Russell
Affiliation:
Clinical Epidemiology and Infection Prevention, UCLA Health System, Los Angeles, California
Susan E. Beekmann
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Philip M. Polgreen
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Zachary Rubin
Affiliation:
Infectious Diseases, David Geffen School of Medicine/University of California, Los Angeles, Los Angeles, California
Daniel Z. Uslan*
Affiliation:
Infectious Diseases, David Geffen School of Medicine/University of California, Los Angeles, Los Angeles, California
*
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 (duslan@mednet.ucla.edu).
Get access Rights & Permissions [Opens in a new window]

Abstract

BACKGROUND

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.

OBJECTIVE

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

DESIGN

Cross-sectional survey.

PARTICIPANTS

Total of 751 physician members of the Emerging Infections Network.

METHODS

An 8-question electronic survey distributed by email.

RESULTS

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.

CONCLUSIONS

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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 1 , January 2016 , pp. 36 - 40
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

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

References

REFERENCES

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:S65–S164.CrossRefGoogle ScholarPubMed
2. Climo, MW, Yokoe, DS, Warren, DK, et al. Effect of daily chlorhexidine bathing on hospital-acquired infection. N Engl J Med 2013;368:533–542.Google Scholar
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;42:1552–1560.Google Scholar
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;35:1156–1162.CrossRefGoogle ScholarPubMed
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;36:192–197.Google Scholar
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;88:170–176.Google Scholar
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;34:1118–1120.Google Scholar
8. Day, HR, Perencevich, EN, Harris, AD, et al. Depression, anxiety, and moods of hospitalized patients under contact precautions. Infect Control Hosp Epidemiol 2013;34:251–258.Google Scholar
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;174:814–815.CrossRefGoogle ScholarPubMed
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;34:69–73.Google Scholar
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;33:849–852.CrossRefGoogle ScholarPubMed
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;34:1087–1093.Google Scholar
13. Dhar, S, Marchaim, D, Tansek, R, et al. Contact precautions: more is not necessarily better. Infect Control Hosp Epidemiol 2014;35:213–221.Google Scholar
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;36:1163–1172.CrossRefGoogle ScholarPubMed
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.Google Scholar