Control of drug-resistant pathogens in endemic settings: contact precautions, controversies, and a proposal for a less restrictive alternative

Area of Science:

• Infection Prevention and Control
• Microbiology
• Public Health

Background:

• Contact precautions are standard for controlling multidrug-resistant organisms (MDROs).
• Evidence for the added benefit of gowns, gloves, and active detection/isolation for preventing cross-transmission in endemic settings is limited.
• Adverse effects of contact precautions, such as patient dissatisfaction and medication errors, have been noted.

Purpose of the Study:

• To evaluate the necessity and effectiveness of current contact precaution measures.
• To explore alternative infection prevention strategies for MDROs.
• To assess the potential harms associated with contact precautions.

Main Methods:

• Review of existing literature on contact precautions and multidrug-resistant organisms.
• Analysis of studies on universal gloving strategies.
• Discussion of the principles of horizontal infection prevention strategies.

Main Results:

• The incremental benefit of contact precautions, including gowns and gloves, for controlling endemic MDROs is not well-established.
• Universal gloving has yielded mixed results and raises concerns about hand hygiene compliance.
• Negative impacts on patient care and provider interactions have been associated with contact precautions.

Conclusions:

• A comprehensive, horizontal infection prevention strategy implementing best practices may be a sufficient and less restrictive approach.
• Rethinking the routine use of contact precautions is warranted.
• Focusing on consistent implementation of fundamental infection control measures could effectively manage endemic MDROs.