title: Degowning the controversies of contact precautions for methicillin-resistant Staphylococcus aureus: A review.
abstract: BACKGROUND
  Contact precautions (CPs) are recommended to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission in institutions. Rising doubts about CP effectiveness and recognition of unintended consequences for patients have raised questions about the benefit. The objective of this study was to evaluate the effectiveness and adverse outcomes associated with CPs for prevention of MRSA transmission.
  
  
  METHODS
  We searched PubMed, Embase, and the Cochrane Library for articles related to effectiveness and adverse outcomes of CPs in patients with MRSA. Criteria for inclusion included the following: articles conducted in the United States, articles performed in an acute care setting, articles that were not a case series or review, and those with standardized collection of data or inclusion of case and control groups. Results were summarized and examined for potential limitations. Recommendations were based on our findings.
  
  
  RESULTS
  CPs reduced MRSA transmission in epidemic settings and in instances with high compliance, but a decrease in infection rates was not shown. Unintended consequences of CPs include decreased health care provider (HCP) time spent with patients, low HCP compliance, decreased perceptions of comfort from patients, and greater likelihood of patient complaints and negative psychologic implications.
  
  
  CONCLUSIONS
  In endemic settings, there are few data to support routine use of CPs to control the spread of MRSA. Education should be performed in hospitals to improve patients' perception of care and understanding of CPs when implemented and HCPs' adherence to good hand hygiene and standard precautions practices.
authors.affiliation: Department of Medical Affairs, Cubist Pharmaceuticals, Lexington, MA. Electronic address: ravina.kullar@gmail.com.
authors.forename: Ravina
authors.initials: R
authors.lastname: Kullar
authors.affiliation: Department of Infection Prevention/Epidemiology, Providence Saint John's Health Center, Santa Monica, CA.
authors.forename: Angela
authors.initials: A
authors.lastname: Vassallo
authors.affiliation: Department of Infection Prevention/Epidemiology, Providence Saint John's Health Center, Santa Monica, CA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Turkel
authors.affiliation: Department of Medicine, Wayne State University and Detroit Medical Center, Detroit, MI.
authors.forename: Teena
authors.initials: T
authors.lastname: Chopra
authors.affiliation: Department of Medicine, Wayne State University and Detroit Medical Center, Detroit, MI.
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center, John D Dingell Veterans Affairs Medical Center, Wayne State University, Detroit, MI. Electronic address: sdhar@med.wayne.edu.
authors.forename: Sorabh
authors.initials: S
authors.lastname: Dhar
mesh_terms: D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D019983:Guideline Adherence; D063373:Hand Hygiene; D006282:Health Personnel; D006761:Hospitals; D006801:Humans; D017053:Infection Control; D055624:Methicillin-Resistant Staphylococcus aureus / Q000502:physiology*; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D014481:United States / Q000453:epidemiology; D016635:Universal Precautions
keywords: Barrier precautions; Contact isolation; Contact precautions; Gloves; Gowning; Hand hygiene; Infection prevention; Methicillin-resistant Staphylococcus aureus; Standard precautions; Transmission-based precautions