Reconsidering contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant...

Area of Science:

• Infectious Disease Epidemiology
• Hospital Infection Prevention
• Antimicrobial Resistance Control

Background:

• The necessity of contact precautions (CP) for controlling endemic methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) in acute care settings remains debated.
• Advances in hand hygiene, decolonization, environmental cleaning, and disinfection challenge traditional CP protocols.

Purpose of the Study:

• To develop a decision-making framework for CP use against endemic MRSA and VRE.
• To review evidence on CP's impact on patients and care processes.
• To assess current CP practices in US hospitals.

Main Methods:

• A comprehensive literature review was conducted.
• A survey of Society for Healthcare Epidemiology of America Research Network members assessed CP usage.
• The experiences of hospitals not employing CP for MRSA/VRE were examined.

Main Results:

• No high-quality data definitively support or refute the use of CP for endemic MRSA or VRE.
• Over 90% of surveyed hospitals utilize CP for MRSA and VRE, with 60% considering alternative approaches.
• More than 30 US hospitals do not use CP for endemic MRSA or VRE control.

Conclusions:

• Further high-quality research is essential to evaluate the benefits and risks of CP for endemic MRSA and VRE.
• In the interim, acute care hospitals should base CP decisions for MRSA and VRE on local requirements and available resources.