Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-29T10:27:19.223Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Part of: SHEA Research Network Collection

Published online by Cambridge University Press:  03 July 2015

Daniel J. Morgan ,
Rekha Murthy ,
L. Silvia Munoz-Price ,
Marsha Barnden ,
Bernard C. Camins ,
B. Lynn Johnston ,
Zachary Rubin ,
Kaede V. Sullivan ,
Andi L. Shane  and
E. Patchen Dellinger
...Show all authors
Daniel J. Morgan*
Affiliation:
University of Maryland, Baltimore, Maryland
Rekha Murthy
Affiliation:
Cedars-Sinai Medical Center, Los Angeles, California
L. Silvia Munoz-Price
Affiliation:
Medical College of Wisconsin, Milwaukee, Wisconsin
Marsha Barnden
Affiliation:
Adventist Health System, Roseville, California
Bernard C. Camins
Affiliation:
University of Alabama at Birmingham, Birmingham, Alabama
B. Lynn Johnston
Affiliation:
Dalhousie University, Halifax, Nova Scotia
Zachary Rubin
Affiliation:
David Geffen School of Medicine at UCLA, Los Angeles, California
Kaede V. Sullivan
Affiliation:
Clinical Microbiology Laboratory, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Andi L. Shane
Affiliation:
Emory University School of Medicine, Atlanta, Georgia
E. Patchen Dellinger
Affiliation:
Department of Surgery, University of Washington Medical Center, Seattle, Washington
Mark E. Rupp
Affiliation:
University of Nebraska Medical Center, Omaha, Nebraska
Gonzalo Bearman
Affiliation:
Medical College of Virginia, Richmond, Virginia
*
Address correspondence to Daniel J. Morgan, MD, MS, 685 W. Baltimore St, MSTF 334, University of Maryland, Baltimore, MD 21201 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 10 , October 2015 , pp. 1163 - 1172
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Fätkenheuer, G, Hirschel, B, Harbarth, S. Screening and isolation to control meticillin-resistant Staphylococcus aureus: sense, nonsense, and evidence. Lancet 2014;385:1146–1149.CrossRefGoogle ScholarPubMed
2. Morgan, DJ, Kaye, KS, Diekema, DJ. Reconsidering isolation precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant. Enterococcus. JAMA 2015;312:1395–1396.CrossRefGoogle Scholar
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;34:69–73.CrossRefGoogle ScholarPubMed
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;35:772–796.Google Scholar
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.Google Scholar
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;35:650–655.CrossRefGoogle ScholarPubMed
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;34:476–483.CrossRefGoogle Scholar
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;52:2003–2009.CrossRefGoogle ScholarPubMed
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;299:1149–1157.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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;14:31–39.Google Scholar
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;364:1407–1418.CrossRefGoogle ScholarPubMed
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;43:971–978.CrossRefGoogle ScholarPubMed
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;31:1051–1057.CrossRefGoogle ScholarPubMed
15. Robicsek, A, Beaumont, JL, Paule, SM, et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008;148:409–418.Google Scholar
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;310:1571–1580.Google Scholar
17. Jain, R, Kralovic, SM, Evans, ME, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011;364:1419–1430.CrossRefGoogle ScholarPubMed
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.Google Scholar
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;45:184–188.CrossRefGoogle Scholar
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;45:158–162.Google Scholar
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;12:345–350.Google Scholar
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;124:498–503.Google Scholar
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;74:370–376.CrossRefGoogle ScholarPubMed
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;4:1559–1564.CrossRefGoogle Scholar
25. Nolan, SM, Gerber, JS, Zaoutis, T, et al. Outbreak of vancomycin-resistant Enterococcus colonization among pediatric oncology patients. Infect Control Hosp Epidemiol 2009;30:338–345.CrossRefGoogle ScholarPubMed
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.Google Scholar
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;14:354–360.Google Scholar
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;27:1061–1064.Google Scholar
29. Schmidt-Hieber, M, Blau, IW, Schwartz, S, et al. Intensified strategies to control vancomycin-resistant enterococci in immunocompromised patients. Int J Hematol 2007;86:158–162.Google Scholar
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;67:42–48.Google Scholar
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;28:493–495.Google Scholar
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;58:97–103.CrossRefGoogle Scholar
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;25:391–394.Google Scholar
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;31:491–497.Google Scholar
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;69:1185–1192.Google Scholar
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;125:448–456.CrossRefGoogle Scholar
37. Evans, HL, Shaffer, MM, Hughes, MG, et al. Contact isolation in surgical patients: a barrier to care? Surgery 2003;134:180–188.CrossRefGoogle ScholarPubMed
38. Kirkland, KB, Weinstein, JM. Adverse effects of contact isolation. Lancet 1999;354:1177–1178.Google Scholar
39. Klein, BS, Perloff, WH, Maki, DG. Reduction of nosocomial infection during pediatric intensive care by protective isolation. N Engl J Med 1989;320:1714–1721.Google Scholar
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.Google Scholar
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;31:354–356.CrossRefGoogle ScholarPubMed
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;75:99–102.CrossRefGoogle ScholarPubMed
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;32:298–299.Google Scholar
44. Goldszer, RC, Tamplin, E, Yokoe, DS, et al. A program to remove patients from unnecessary contact precautions. J Clin Outcomes Manag 2002;9:553–556.Google Scholar
45. Stelfox, HT, Bates, DW, Redelmeier, DA. Safety of patients isolated for infection control. JAMA 2003;290:1899–1905.Google Scholar
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;34:1118–1120.Google Scholar
47. Catalano, G, Houston, SH, Catalano, MC, et al. Anxiety and depression in hospitalized patients in resistant organism isolation. South Med J 2003;96:141–145.Google Scholar
48. Davies, H, Rees, J. Psychological effects of isolation nursing, 1: mood disturbance. Nurs Stand 2000;14:35–38.CrossRefGoogle ScholarPubMed
49. Rees, J, Davies, HR, Birchall, C, Price, J. Psychological effects of source isolation nursing, 2: patient satisfaction. Nurs Stand 2000;14:32–36.Google Scholar
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;33:34–39.Google Scholar
51. Gammon, J. Analysis of the stressful effects of hospitalisation and source isolation on coping and psychological constructs. Int J Nurs Pract 1998;4:84–96.CrossRefGoogle ScholarPubMed
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;35:617–619.CrossRefGoogle ScholarPubMed
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;39:163–165.Google Scholar
54. Knowles, HE. The experience of infectious patients in isolation. Nurs Times 1993;89:53–56.Google Scholar
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;49:250–254.Google Scholar
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;79:103–107.CrossRefGoogle Scholar
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:e411–e415.Google Scholar
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;34:1087–1093.Google Scholar
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;29:275–278.CrossRefGoogle ScholarPubMed
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:S165–S193.CrossRefGoogle ScholarPubMed
61. Dhar, S, Marchaim, D, Tansek, R, et al. Contact precautions: more is not necessarily better. Infect Control Hosp Epidemiol 2014;35:213–221.CrossRefGoogle Scholar
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;57:176–184.Google Scholar
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.Google Scholar
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;88:170–176.CrossRefGoogle ScholarPubMed
65. Haessler, S. MRSA success stories. In Proceedings of SHEA Spring Conference 2014. Denver, CO: SHEA, 2014.Google Scholar
66. Kirkland, KB. Taking off the gloves: toward a less dogmatic approach to the use of contact isolation. Clin Infect Dis 2009;48:766–771.Google Scholar
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;31:779–783.CrossRefGoogle Scholar
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;38:931–939.Google Scholar