Routine Use of Contact Precautions for Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus: Which Way Is the Pendulum Swinging?
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.
1Clinical Epidemiology and Infection Prevention,UCLA Health System,Los Angeles,California.
Dana
D
Russell
2Division of Infectious Diseases,Department of Internal Medicine,University of Iowa Carver College of Medicine,Iowa City,Iowa.
Susan E
SE
Beekmann
2Division of Infectious Diseases,Department of Internal Medicine,University of Iowa Carver College of Medicine,Iowa City,Iowa.
Philip M
PM
Polgreen
3Infectious Diseases,David Geffen School of Medicine/University of California,Los Angeles,Los Angeles,California.
Zachary
Z
Rubin
3Infectious Diseases,David Geffen School of Medicine/University of California,Los Angeles,Los Angeles,California.
Daniel Z
DZ
Uslan
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D001494:Baths / Q000706:statistics & numerical data; D002710:Chlorhexidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004203:Disinfection / Q000379:methods; D016908:Gram-Positive Bacterial Infections / Q000517:prevention & control*; D006801:Humans; D006861:Hydrogen Peroxide; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D016712:Mupirocin / Q000627:therapeutic use; D010356:Patient Isolation / Q000379:methods*; D010362:Patients' Rooms; D013203:Staphylococcal Infections / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D014466:Ultraviolet Rays; D014481:United States; D065507:Vancomycin-Resistant Enterococci / Q000302:isolation & purification
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D006861:Hydrogen Peroxide; D016712:Mupirocin; C010882:chlorhexidine gluconate; D002710:Chlorhexidine