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Routine Use of Contact Precautions for Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus: Which Way Is the Pendulum Swinging?

Published online by Cambridge University Press:  21 October 2015

Dana Russell ,
Susan E. Beekmann ,
Philip M. Polgreen ,
Zachary Rubin  and
Daniel Z. Uslan
Dana Russell
Affiliation:
Clinical Epidemiology and Infection Prevention, UCLA Health System, Los Angeles, California
Susan E. Beekmann
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Philip M. Polgreen
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Zachary Rubin
Affiliation:
Infectious Diseases, David Geffen School of Medicine/University of California, Los Angeles, Los Angeles, California
Daniel Z. Uslan*
Affiliation:
Infectious Diseases, David Geffen School of Medicine/University of California, Los Angeles, Los Angeles, California
*
Address correspondence to Daniel Z. Uslan, MD, MS, FIDSA, FSHEA, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, 37-121 CHS, Los Angeles, CA 90095 ([email protected]).
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Abstract

BACKGROUND

Studies have suggested that contact precautions (CP) for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus may have risks that outweigh the benefits. These risks, coupled with more widespread use of horizontal interventions such as daily bathing with chlorhexidine gluconate, have brought into question the value of routine CP for these organisms.

OBJECTIVE

To assess the state of utilization of CP as well as adjunctive measures to reduce the risk of transmission in US hospitals.

DESIGN

Cross-sectional survey.

PARTICIPANTS

Total of 751 physician members of the Emerging Infections Network.

METHODS

An 8-question electronic survey distributed by email.

RESULTS

A total of 426/751 (57%) responded to the survey; 337/364 (93%) of respondents use routine CP for methicillin-resistant S. aureus and 335/364 (92%) use routine CP for vancomycin-resistant enterococcus. The most widely used trigger for initiation of CP for both pathogens was positive clinical culture. Practices for discontinuation of isolation varied widely. We found that 325/354 (92%) perform routine chlorhexidine gluconate bathing and 236/353 (67%) perform S. aureus decolonization with mupirocin for 1 or more subsets of inpatients, and 82/356 (23%) reported using either hydrogen peroxide vapor or ultraviolet-C room disinfection at discharge. Free text responses noted frustration and variation in the application, practice, and process for initiation and discontinuation of CP.

CONCLUSIONS

Use of CP for methicillin-resistant S. aureus and vancomycin-resistant enterococcus remains commonplace, although horizontal interventions such as chlorhexidine gluconate bathing are increasingly used. The heterogeneity of practices and policies was striking. Evidence-based guidelines regarding CP and horizontal interventions are needed.

Infect. Control Hosp. Epidemiol. 2015;37(1):36–40

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 1 , January 2016 , pp. 36 - 40
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Presented in part: IDWeek 2014; Philadelphia, Pennsylvania; October 8–12, 2014, abstract #6820.

References

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