January 13, 2021
Reviewed by Zeina A. Kanafani, MD, MS, FIDSA
Infection control programs have long advocated for the use of contact precautions (CP) for patients with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) colonization and infection. However, this practice has been challenged by recent evidence stating that CP are only helpful in the setting of hospital outbreaks, particularly since MRSA and VRE have become endemic in many hospitals in the United States.
In this retrospective study conducted at three university hospitals (A, B, and C) and published in the American Journal of Infection Control, the authors assessed the effect of stopping the routine use of CP for MRSA and VRE. Other infection control targets during the study period included hand hygiene, device-associated infections, chlorhexidine baths, as well as environmental cleaning processes. Routine CP were discontinued in 2004 in hospital A, in 2014 in hospital B, and in 2013 in hospital C.
Central line-associated bloodstream infection rates decreased over time in all three hospitals, but there was no statistically significant association with CP discontinuation. With respect to catheter-associated urinary tract infections (CAUTIs), decreasing temporal trends were observed in hospitals A and C with no association with CP discontinuation. In hospital B, however, there was a significant drop in CAUTI rates significantly associated with CP discontinuation (-3.210; P = .009). Mediastinal surgical site infection rates were also analyzed at hospitals A and C with no intervention effects for CP discontinuation. Finally, ventilator-associated pneumonia rates at all three hospitals were indifferent to CP discontinuation. The overall findings showed no statistically significant increase after CP discontinuation in any of the types of infections assessed for all organisms or for infections caused specifically by MRSA and VRE.
The authors conclude that stopping the routine use of CP for MRSA and VRE is safe and bears no apparent negative effects on hospital infection rates. However, they emphasize the importance of all other infection control measures which should be greatly adhered to. Additional prospective studies are needed to validate the findings in this study.