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Reconsidering Contact Precautions for Endemic Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus

  • Daniel J. Morgan (a1), Rekha Murthy (a2), L. Silvia Munoz-Price (a3), Marsha Barnden (a4), Bernard C. Camins (a5), B. Lynn Johnston (a6), Zachary Rubin (a7), Kaede V. Sullivan (a8), Andi L. Shane (a9), E. Patchen Dellinger (a10), Mark E. Rupp (a11) and Gonzalo Bearman (a12)...
Abstract
BACKGROUND

Whether contact precautions (CP) are required to control the endemic transmission of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) in acute care hospitals is controversial in light of improvements in hand hygiene, MRSA decolonization, environmental cleaning and disinfection, fomite elimination, and chlorhexidine bathing.

OBJECTIVE

To provide a framework for decision making around use of CP for endemic MRSA and VRE based on a summary of evidence related to use of CP, including impact on patients and patient care processes, and current practices in use of CP for MRSA and VRE in US hospitals.

DESIGN

A literature review, a survey of Society for Healthcare Epidemiology of America Research Network members on use of CP, and a detailed examination of the experience of a convenience sample of hospitals not using CP for MRSA or VRE.

PARTICIPANTS

Hospital epidemiologists and infection prevention experts.

RESULTS

No high quality data support or reject use of CP for endemic MRSA or VRE. Our survey found more than 90% of responding hospitals currently use CP for MRSA and VRE, but approximately 60% are interested in using CP in a different manner. More than 30 US hospitals do not use CP for control of endemic MRSA or VRE.

CONCLUSIONS

Higher quality research on the benefits and harms of CP in the control of endemic MRSA and VRE is needed. Until more definitive data are available, the use of CP for endemic MRSA or VRE in acute care hospitals should be guided by local needs and resources.

Infect Control Hosp Epidemiol 2015;36(10):1163–1172

Copyright
Corresponding author
Address correspondence to Daniel J. Morgan, MD, MS, 685 W. Baltimore St, MSTF 334, University of Maryland, Baltimore, MD 21201 (dmorgan@epi.umaryland.edu).
References
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1. Fätkenheuer G, Hirschel B, Harbarth S. Screening and isolation to control meticillin-resistant Staphylococcus aureus: sense, nonsense, and evidence. Lancet 2014;385:11461149.
2. Morgan DJ, Kaye KS, Diekema DJ. Reconsidering isolation precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant. Enterococcus. JAMA 2015;312:13951396.
3. Morgan DJ, Pineles L, Shardell M, et al. The effect of contact precautions on healthcare worker activity in acute care hospitals. Infect Control Hosp Epidemiol 2013;34:6973.
4. Calfee DP, Salgado CD, Milstone AM, et al. Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:772796.
5. CDC/HICPAC. Prevention of transmission of multidrug resistant organisms 2009. www.cdc.gov/hicpac/mdro/mdro_5.html. Updated December 29, 2009. Accessed November 2014.
6. Bearman GM, Marra AR, Sessler CN, et al. A controlled trial of universal gloving versus contact precautions for preventing the transmission of multidrug-resistant organisms. Am J Infect Control 2007;35:650655.
7. Safdar N, Marx J, Meyer NA, Maki DG. Effectiveness of preemptive barrier precautions in controlling nosocomial colonization and infection by methicillin-resistant Staphylococcus aureus in a burn unit. Am J Infect Control 2006;34:476483.
8. Trick WE, Weinstein RA, DeMarais PL, et al. Comparison of routine glove use and contact-isolation precautions to prevent transmission of multidrug-resistant bacteria in a long-term care facility. J Am Geriatr Soc 2004;52:20032009.
9. Harbarth S, Fankhauser C, Schrenzel J, et al. Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA 2008;299:11491157.
10. Marshall C, Richards M, McBryde E. Do active surveillance and contact precautions reduce MRSA acquisition? A prospective interrupted time series. PLOS ONE 2013;8:e58112.
11. Derde LP, Cooper BS, Goossens H, et al. Interventions to reduce colonisation and transmission of antimicrobial-resistant bacteria in intensive care units: an interrupted time series study and cluster randomised trial. Lancet Infect Dis 2014;14:3139.
12. Huskins WC, Huckabee CM, O’Grady NP, et al. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 2011;364:14071418.
13. Huang SS, Yokoe DS, Hinrichsen VL, et al. Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2006;43:971978.
14. Lucet JC, Paoletti X, Lolom I, et al. Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med 2005;31:10511057.
15. Robicsek A, Beaumont JL, Paule SM, et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008;148:409418.
16. Harris AD, Pineles L, Belton B, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA 2013;310:15711580.
17. Jain R, Kralovic SM, Evans ME, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011;364:14191430.
18. Fournier S, Monteil C, Lepainteur M, et al. Long-term control of carbapenemase-producing Enterobacteriaceae at the scale of a large French multihospital institution, a nine-year experience, France, 2004 to 2012. Euro Surveill 2014;19. pii:20802.
19. Rossini FA, Fagnani R, Leichsenring ML, et al. Successful prevention of the transmission of vancomycin-resistant enterococci in a Brazilian public teaching hospital. Rev Soc Bras Med Trop 2012;45:184188.
20. Carmona F, Prado SI, Silva MF, et al. Vancomycin-resistant Enterococcus outbreak in a pediatric intensive care unit: report of successful interventions for control and prevention. Braz J Med Biol Res 2012;45:158162.
21. Rosenberger LH, Hranjec T, Politano AD, et al. Effective cohorting and “superisolation” in a single intensive care unit in response to an outbreak of diverse multi-drug-resistant organisms. Surg Infect (Larchmt) 2011;12:345350.
22. Xu HT, Tian R, Chen DK, et al. Nosocomial spread of hospital-adapted CC17 vancomycin-resistant Enterococcus faecium in a tertiary-care hospital of Beijing, China. Chin Med J (Engl) 2011;124:498503.
23. Ergaz Z, Arad I, Bar-Oz B, et al. Elimination of vancomycin-resistant enterococci from a neonatal intensive care unit following an outbreak. J Hosp Infect 2010;74:370376.
24. Servais A, Mercadal L, Brossier F, et al. Rapid curbing of a vancomycin-resistant Enterococcus faecium outbreak in a nephrology department. Clin J Am Soc Nephrol 2009;4:15591564.
25. Nolan SM, Gerber JS, Zaoutis T, et al. Outbreak of vancomycin-resistant Enterococcus colonization among pediatric oncology patients. Infect Control Hosp Epidemiol 2009;30:338345.
26. Cheng VC, Chan JF, Tai JW, et al. Successful control of vancomycin-resistant Enterococcus faecium outbreak in a neurosurgical unit at non-endemic region. Emerg Health Threats J 2009;2:e9.
27. Hoshuyama T, Moriguchi H, Muratani T, Matsumoto T. Vancomycin-resistant enterococci (VRE) outbreak at a university hospital in Kitakyushu, Japan: case-control studies. J Infect Chemother 2008;14:354360.
28. Aumeran C, Baud O, Lesens O, Delmas J, Souweine B, Traoré O. Successful control of a hospital-wide vancomycin-resistant Enterococcus faecium outbreak in France. Eur J Clin Microbiol Infect Dis 2008;27:10611064.
29. Schmidt-Hieber M, Blau IW, Schwartz S, et al. Intensified strategies to control vancomycin-resistant enterococci in immunocompromised patients. Int J Hematol 2007;86:158162.
30. Lucet JC, Armand-Lefevre L, Laurichesse JJ, et al. Rapid control of an outbreak of vancomycin-resistant enterococci in a French university hospital. J Hosp Infect 2007;67:4248.
31. Yoonchang SW, Peck KR, Kim OS, et al. Efficacy of infection control strategies to reduce transmission of vancomycin-resistant enterococci in a tertiary care hospital in Korea: a 4-year follow-up study. Infect Control Hosp Epidemiol 2007;28:493495.
32. Wang JT, Chen YC, Chang SC, et al. Control of vancomycin-resistant enterococci in a hospital: a five-year experience in a Taiwanese teaching hospital. J Hosp Infect 2004;58:97103.
33. Hachem R, Graviss L, Hanna H, et al. Impact of surveillance for vancomycin-resistant enterococci on controlling a bloodstream outbreak among patients with hematologic malignancy. Infect Control Hosp Epidemiol 2004;25:391394.
34. Bearman G, Rosato AE, Duane TM, et al. Trial of universal gloving with emollient-impregnated gloves to promote skin health and prevent the transmission of multidrug-resistant organisms in a surgical intensive care unit. Infect Control Hosp Epidemiol 2010;31:491497.
35. De Angelis G, Cataldo MA, De Waure C, et al. Infection control and prevention measures to reduce the spread of vancomycin-resistant enterococci in hospitalized patients: a systematic review and meta-analysis. J Antimicrob Chemother 2014;69:11851192.
36. Slaughter S, Hayden MK, Nathan C, et al. A comparison of the effect of universal use of gloves and gowns with that of glove use alone on acquisition of vancomycin-resistant enterococci in a medical intensive care unit. Ann Intern Med 1996;125:448456.
37. Evans HL, Shaffer MM, Hughes MG, et al. Contact isolation in surgical patients: a barrier to care? Surgery 2003;134:180188.
38. Kirkland KB, Weinstein JM. Adverse effects of contact isolation. Lancet 1999;354:11771178.
39. Klein BS, Perloff WH, Maki DG. Reduction of nosocomial infection during pediatric intensive care by protective isolation. N Engl J Med 1989;320:17141721.
40. Masse V, Valiquette L, Boukhoudmi S, et al. Impact of methicillin resistant Staphylococcus aureus contact isolation units on medical care. PLOS ONE 2013;8:e57057.
41. Saint S, Higgins LA, Nallamothu BK, Chenoweth C. Do physicians examine patients in contact isolation less frequently? A brief report. Am J Infect Control 2003;31:354356.
42. Gilligan P, Quirke M, Winder S, Humphreys H. Impact of admission screening for methicillin-resistant Staphylococcus aureus on the length of stay in an emergency department. J Hosp Infect 2010;75:99102.
43. McLemore A, Bearman G, Edmond MB. Effect of contact precautions on wait time from emergency room disposition to inpatient admission. Infect Control Hosp Epidemiol 2011;32:298299.
44. Goldszer RC, Tamplin E, Yokoe DS, et al. A program to remove patients from unnecessary contact precautions. J Clin Outcomes Manag 2002;9:553556.
45. Stelfox HT, Bates DW, Redelmeier DA. Safety of patients isolated for infection control. JAMA 2003;290:18991905.
46. Karki S, Leder K, Cheng AC. Patients under contact precautions have an increased risk of injuries and medication errors: a retrospective cohort study. Infect Control Hosp Epidemiol 2013;34:11181120.
47. Catalano G, Houston SH, Catalano MC, et al. Anxiety and depression in hospitalized patients in resistant organism isolation. South Med J 2003;96:141145.
48. Davies H, Rees J. Psychological effects of isolation nursing, 1: mood disturbance. Nurs Stand 2000;14:3538.
49. Rees J, Davies HR, Birchall C, Price J. Psychological effects of source isolation nursing, 2: patient satisfaction. Nurs Stand 2000;14:3236.
50. Day HR, Perencevich EN, Harris AD, et al. Association between contact precautions and delirium at a tertiary care center. Infect Control Hosp Epidemiol 2012;33:3439.
51. Gammon J. Analysis of the stressful effects of hospitalisation and source isolation on coping and psychological constructs. Int J Nurs Pract 1998;4:8496.
52. Kennedy P, Hamilton LR. Psychological impact of the management of methicillin-resistant Staphylococcus aureus (MRSA) in patients with spinal cord injury. Spinal Cord 1997;35:617619.
53. Day HR, Morgan DJ, Himelhoch S, Young A, Perencevich EN. Association between depression and contact precautions in veterans at hospital admission. Am J Infect Control 2011;39:163165.
54. Knowles HE. The experience of infectious patients in isolation. Nurs Times 1993;89:5356.
55. Tarzi S, Kennedy P, Stone S, Evans M. Methicillin-resistant Staphylococcus aureus: psychological impact of hospitalization and isolation in an older adult population. J Hosp Infect 2001;49:250254.
56. Day HR, Perencevich EN, Harris AD, et al. Do contact precautions cause depression? A two-year study at a tertiary care medical centre. J Hosp Infect 2011;79:103107.
57. Cohen E, Austin J, Weinstein M, Matlow A, Redelmeier DA. Care of children isolated for infection control: a prospective observational cohort study. Pediatrics 2008;122:e411e415.
58. Mehrotra P, Croft L, Day HR, et al. Effects of contact precautions on patient perception of care and satisfaction: a prospective cohort study. Infect Control Hosp Epidemiol 2013;34:10871093.
59. Gasink LB, Singer K, Fishman NO, et al. Contact isolation for infection control in hospitalized patients: is patient satisfaction affected? Infect Control Hosp Epidemiol 2008;29:275278.
60. Siegel JD, Rhinehart E, Jackson M, Chiarello L, Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007;35:S165S193.
61. Dhar S, Marchaim D, Tansek R, et al. Contact precautions: more is not necessarily better. Infect Control Hosp Epidemiol 2014;35:213221.
62. Shenoy ES, Kim J, Rosenberg ES, et al. Discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus: a randomized controlled trial comparing passive and active screening with culture and polymerase chain reaction. Clin Infect Dis 2013;57:176184.
63. Edmond M. Panel on clinical controversies in ID. In: Program and abstracts of IDWeek 2014; Philadelphia, PA; October 9, 2014. Abstract 18. https://idsa.confex.com/idsa/2014/webprogram/Session6312.html. Accessed November 2014.
64. Gandra S, Barysauskas CM, Mack DA, Barton B, Finberg R, Ellison RT. Impact of contact precautions on falls, pressure ulcers and transmission of MRSA and VRE in hospitalized patients. J Hosp Infect 2014;88:170176.
65. Haessler S. MRSA success stories. In Proceedings of SHEA Spring Conference 2014. Denver, CO: SHEA, 2014.
66. Kirkland KB. Taking off the gloves: toward a less dogmatic approach to the use of contact isolation. Clin Infect Dis 2009;48:766771.
67. Fraser TG, Fatica C, Scarpelli M, et al. Decrease in Staphylococcus aureus colonization and hospital-acquired infection in a medical intensive care unit after institution of an active surveillance and decolonization program. Infect Control Hosp Epidemiol 2010;31:779783.
68. Derde LP, Dautzenberg MJ, Bonten MJ. Chlorhexidine body washing to control antimicrobial-resistant bacteria in intensive care units: a systematic review. Intensive Care Med 2012;38:931939.
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