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Physicians report routine use of contact precautions for MRSA, VRE
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The routine use of contact precautions for patients infected with MRSA or vancomycin-resistant Enterococcus appeared to be common and highly heterogeneous, according to recent survey results published in Infection Control and Hospital Epidemiology.
“We were surprised by how many respondents report using [contact precautions (CP)] routinely,” the researchers wrote. “We perceive from the literature plus conversations with health care epidemiology colleagues that CP for MRSA and [vancomycin-resistant Enterococcus (VRE)] is falling out of favor. However, although many institutions may contemplate discontinuing routine CP for MRSA and VRE, the effort involved may be a significant disincentive to change.”
Researchers distributed an eight-question electronic survey to physicians within the Emerging Infections Network. Responses were discrete and chosen from a set of predetermined answers, but included a free text field for additional comments from the respondents. After allowing 3 weeks for physicians to respond, researchers compiled and analyzed the data to identify current CP practices.
Among the 364 responders included in analysis, 93% and 92% reported using routine CP for MRSA and VRE, respectively. Positive clinical culture was the most frequently reported trigger for CP initiation. Chlorhexidine gluconate bathing was used by 85% of respondents, and Staphylococcus aureus decolonization with intranasal mupirocin was used by 64%. Patient room disinfection using either ultraviolet-C light or hydrogen peroxide vapor was reported by 23% of respondents, and approximately half monitored cleaning performance by visual inspection.
“Although routine CP for MRSA and VRE remains a standard at most hospitals across the country after decades of use, robust studies demonstrating the benefits of CP for these organisms, outside of the outbreak setting, are lacking in the medical literature,” they wrote. “As additional studies better elucidate the risks and benefits of CP relative to horizontal interventions in the future, professional societies and regulatory agencies should take into account the trade-offs of routine CP and guide health care facilities to take a more personalized, risk-based approach to applying these measures.” – by Dave Muoio
Disclosure: The researchers report no relevant financial disclosures.
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