Isolation policies in musculoskeletal infection care: time to move from tradition to evidence

Area of Science:

• Infection Control
• Musculoskeletal Infections
• Epidemiology

Background:

• Standard precautions are crucial in healthcare settings.
• Multidrug-resistant organisms (MDROs) pose significant infection control challenges.
• Current isolation practices for musculoskeletal infections vary widely.

Purpose of the Study:

• To evaluate the evidence for routine isolation in musculoskeletal infections.
• To assess the gap between evidence and clinical perception regarding isolation practices.
• To advocate for a differentiated, risk-based approach to infection control.

Main Methods:

• Conducted a scoping review of existing literature.
• Performed an international survey to gauge healthcare professionals' attitudes and beliefs.
• Analyzed evidence versus perceived evidence for isolation strategies.

Main Results:

• No evidence supports routine ward-level isolation for non-MDRO musculoskeletal infections with standard precautions.
• Targeted isolation measures remain appropriate for MDROs.
• Significant variation in attitudes and persistent belief in unsupported evidence were observed.

Conclusions:

• A differentiated, risk-based approach to isolation is warranted.
• Clinical practice should align with evidence, distinguishing between MDRO and non-MDRO infections.
• Addressing the evidence-perception gap is essential for optimizing infection control.