title: Reconsidering contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: 1University of Maryland,Baltimore,Maryland.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Morgan
authors.affiliation: 2Cedars-Sinai Medical Center,Los Angeles,California.
authors.forename: Rekha
authors.initials: R
authors.lastname: Murthy
authors.affiliation: 3Medical College of Wisconsin,Milwaukee,Wisconsin.
authors.forename: L Silvia
authors.initials: LS
authors.lastname: Munoz-Price
authors.affiliation: 4Adventist Health System,Roseville,California.
authors.forename: Marsha
authors.initials: M
authors.lastname: Barnden
authors.affiliation: 5University of Alabama at Birmingham,Birmingham,Alabama.
authors.forename: Bernard C
authors.initials: BC
authors.lastname: Camins
authors.affiliation: 6Dalhousie University,Halifax,Nova Scotia.
authors.forename: B Lynn
authors.initials: BL
authors.lastname: Johnston
authors.affiliation: 7David Geffen School of Medicine at UCLA,Los Angeles,California.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Rubin
authors.affiliation: 8Clinical Microbiology Laboratory,Children's Hospital of Philadelphia,Philadelphia,Pennsylvania.
authors.forename: Kaede V
authors.initials: KV
authors.lastname: Sullivan
authors.affiliation: 9Emory University School of Medicine,Atlanta,Georgia.
authors.forename: Andi L
authors.initials: AL
authors.lastname: Shane
authors.affiliation: 10Department of Surgery,University of Washington Medical Center,Seattle,Washington.
authors.forename: E Patchen
authors.initials: EP
authors.lastname: Dellinger
authors.affiliation: 11University of Nebraska Medical Center,Omaha,Nebraska.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Rupp
authors.affiliation: 12Medical College of Virginia,Richmond,Virginia.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Bearman
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D003428:Cross Infection / Q000517:prevention & control* / Q000635:transmission; D016908:Gram-Positive Bacterial Infections / Q000517:prevention & control* / Q000635:transmission; D019538:Health Care Surveys; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000592:standards; D055624:Methicillin-Resistant Staphylococcus aureus; D017410:Practice Guidelines as Topic; D013203:Staphylococcal Infections / Q000517:prevention & control / Q000635:transmission; D014481:United States; D065507:Vancomycin-Resistant Enterococci