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Considering the precautionary principle and its application to MRSA and SARS-CoV-2 as emerging novel pathogens of
Joanna Harris1, Hazel Maxwell2, Susan Dodds3
1Director of Infection Prevention and Control, Infection Management and Control Service (IMACS), Illawarra Shoalhaven Local Health District (ISLHD), Level 1 Lawson House, Wollongong Hospital, Loftus St, Wollongong 2500, NSW, Australia.
Abstract:
In the 1980s Contact Precautions were introduced as a precautionary measure to control the emerging threat of antimicrobial resistance in hospitals, particularly methicillin resistant Staphylococcus aureus (MRSA). Today, antimicrobial resistance remains a concerning global public health threat, and a focus for hospital patient safety priorities. In late 2019 a novel respiratory virus described as SARS-CoV-2, was reported. Just as MRSA had prompted control measures developed in the context of limited information and understanding of the pathogen, public health control measures against SARS-CoV-2 were promptly and strictly implemented. Whilst SARS-CoV-2 control measures were successful at containing the virus, numerous detrimental socio-economic and health impacts have led to a rebalancing of harms versus benefits and loosening of restrictions. Conversely, evidence collated over the past 50 years, suggests that Contact Precautions are not superior to well-applied standard infection prevention and control precautions in controlling MRSA acquisition in hospitals. Several harms associated with Contact Precautions, affecting patient safety, financial costs, and organisational culture, are described. However, rebalancing of hospital MRSA control policies has been slow to materialise. This commentary invites infection prevention and control policy makers to reflect and revise policies for the control of MRSA in hospitals so that harms do not outweigh benefits.
Insights
Contact Precautions, introduced for methicillin-resistant Staphylococcus aureus (MRSA), may not be superior to standard precautions. Re-evaluating hospital MRSA control policies is crucial to ensure benefits outweigh harms.
Area of Science:
- Infection Prevention and Control
- Hospital Epidemiology
- Antimicrobial Resistance
Background:
- Contact Precautions were implemented in the 1980s to combat antimicrobial resistance, notably methicillin-resistant Staphylococcus aureus (MRSA).
- Antimicrobial resistance remains a significant global health concern and a priority for hospital patient safety.
- The COVID-19 pandemic saw the rapid implementation of strict control measures for SARS-CoV-2, similar to initial responses for emerging pathogens.
Purpose of the Study:
- To critically evaluate the continued necessity and effectiveness of Contact Precautions for MRSA control in hospitals.
- To highlight the potential harms associated with Contact Precautions, including impacts on patient safety, costs, and organizational culture.
- To advocate for a rebalancing of hospital policies regarding MRSA control, considering evidence-based benefits versus harms.
Main Methods:
- Review of evidence on the efficacy of Contact Precautions versus standard infection prevention and control (IPC) for MRSA acquisition over the past 50 years.
- Analysis of documented harms associated with the implementation of Contact Precautions in healthcare settings.
- Comparative assessment of IPC strategies in light of evolving understanding of pathogens and their control.
Main Results:
- Evidence suggests Contact Precautions are not demonstrably superior to well-applied standard IPC in controlling MRSA acquisition.
- Several negative impacts of Contact Precautions have been identified, affecting patient safety, financial expenditure, and the overall hospital organizational culture.
- While SARS-CoV-2 control measures were relaxed due to socio-economic and health impacts, hospital MRSA control policies have been slower to adapt.
Conclusions:
- A reassessment of hospital policies for controlling MRSA is warranted.
- The benefits of Contact Precautions for MRSA may be outweighed by their associated harms.
- Infection prevention and control policymakers should consider revising current MRSA control strategies to optimize patient safety and resource allocation.
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