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Hospitals continue to use contact precautions to control MRSA spread
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A research review and survey on infection control practices published in Infection Control and Hospital Epidemiology suggested that many hospitals use contact precautions to prevent endemic transmission of MRSA and vancomycin-resistant Enterococcus, despite a lack of quality data supporting their effectiveness.
“Despite decades of experience, the use of contact precautions (CP) for endemic [MRSA] and vancomycin-resistant Enterococcus (VRE) remains controversial. As a result, there is a growing diversity of practice for CP in acute care hospitals,” Daniel J. Morgan, MD, MS, associate professor of epidemiology and public health at the University of Maryland, and colleagues wrote.
According to the researchers, CP typically include having all health care workers and visitors wear gowns and gloves upon entering a patient’s room.
The researchers analyzed results from 48 studies that examined the effectiveness of CP in preventing endemic MRSA and 45 that measured the same for VRE infections. While they wrote that several “lower-quality, quasi-experimental studies” showed CP to be effective at reducing MRSA infections, CP was not as successful in higher quality trials.
“In contrast to uncontrolled studies, prospective trials with control groups largely failed to demonstrate a benefit of CP for MRSA,” Morgan and colleagues wrote. “In a prominent controlled quasi-experimental study, Harbarth et al screened surgical patients for MRSA colonization at admission. Using a cross-over design in 12 surgical wards, they compared rapid [active surveillance cultures] with CP to standard infection control measures, which included less frequent CP and decolonization for patients with MRSA by clinical cultures. They observed no difference in MRSA rates between the two periods.”
The researchers wrote that studies on VRE transmission have “not identified a benefit to CP over standard precautions in acute care settings for controlling the spread of VRE.”
In addition to the research review, the researchers conducted a survey of Society for Healthcare Epidemiology of America Research Network members, for which they received 87 responses (response rate, 33%). Ninety-two percent respondents indicated that their health care facilities use CP to prevent transmission of MRSA and VRE.
Of these respondents, 41% said CP have a large impact on preventing MRSA infections, and 36% indicated that CP are critical to preventing VRE infections. They also responded that CP negatively impacted patients through a reduced number of health care-related visits (78%); worsening mental health (68%); and reduced satisfaction (69%). More than 60% of respondents favored using CP for symptoms such as diarrhea, uncontrolled secretions and draining wounds, regardless of whether MRSA and VRE were present, according to the researchers.
“Determining the optimal use of CP is an important issue because it affects 10% to 25% of hospitalized patients, may have a negative impact on patient throughput, and may cause harm and decrease quality of care by reducing HCP-patient contact,” Morgan and colleagues wrote. – by David Jwanier
Disclosure: Morgan reports that he serves in an advisory/consultant role for 3M, Sanogiene/Biomed and Welch Allyn. Please see the full study for a list of all other authors’ relevant financial disclosures.
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