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Universal contact precautions fail to significantly reduce MDROs in ICUs
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The prevalence of multidrug-resistant organisms, or MDROs, did not significantly differ between ICUs with or without universal contact precautions, according to findings recently published in Infection Control & Hospital Epidemiology.
In addition, E. Yoko Furuya, MD, MS, of the division of infectious diseases at Columbia University Medical Center and department of infection prevention and control at New York-Presbyterian Hospital, and colleagues found no evidence that trends in MDRO prevalence changed before or after ICUs implemented universal contact precautions (UCPs) — an intervention the researchers said “has long been controversial.”
“One the one hand, it has been hypothesized that universal barrier precautions may be effective in preventing MDRO transmission, particularly in ICU settings where patients are critically ill and undergoing multiple invasive procedures and device insertions,” the researchers wrote. “On the other hand, there is concern that barrier precautions could have a negative impact, such as a decrease in visits by health care personnel and an increase in adverse events.”
Previously, two randomized controlled trials exploring the impact of contact precautions showed no reduction in MRSA or vancomycin-resistant enterococci (VRE) acquisition, according to the researchers. However, longer term data on the efficacy of UCPs are limited. Therefore, Furuya and colleagues conducted a comparative effectiveness study to further investigate UCP use from 2006 to 2014 at an adult academic medical center in New York City. They compared MDRO incidence in three ICUs without UCPs and three ICUs that implemented UCPs in 2007 to address outbreaks of Clostridium difficile and multidrug-resistant gram-negative bacteria. Although the outbreaks ended within a couple of months, only one ICU discontinued UCP use in July 2009.
The prevalence of MDROs significantly decreased over time in both the intervention group and the control group, and at a similar rate (6.6% vs. 6% per year). In the intervention group, there was no difference in the rate of decline before or after UCP implementation, which suggests that hospitalwide improvements in infection prevention and control practices likely resulted in the reduction of MDRO incidence.
“We did not measure adherence to the universal gowning and gloving intervention; hence, it is possible that if adherence to the intervention declined over time, this decline might dilute the impact of the intervention on MDRO rates,” the researchers noted. “Nonetheless, if this were the case, it probably mimics the true impact over time, were such an intervention to be implemented outside of a study setting.”
Earlier this year, the Society for Healthcare Epidemiology of America issued guidance on when hospital staff should end contact precautions for patients with MDROs. Overall, the guidelines recommend that health care providers base their decision on how long it has been since the last positive culture was taken; however, these recommendations vary based on the type of pathogen.
“The duration of contact precautions can have a significant impact on the health of the patient, the hospital and the community,” guideline co-author Gonzolo Bearman, MD, MPH, chairman of the division of infectious diseases at Virginia Commonwealth University, said in a news release. “This guidance is a starting point. However, stronger research is needed to evaluate and optimize its use.”– by Stephanie Viguers and Joe Green
References:
Banach DB, et al. Infect Control Hosp Epidemiol. 2018;doi:10.1017/ice.2017.245.
Furuya EY, et al. Infect Control Hosp Epidemiol. 2018;doi:10.1017/ice.2018.35.
Disclosures: The authors report no relevant financial disclosures.
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