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Revamping Infection Control Strategies: Assessing the Universal Use of Contact Precautions for MRSA Prevention

A critical examination, recently published in the American Journal of Infection Control (AJIC), raises compelling questions about the conventional practice of employing contact precautions (CP) universally for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) transmission in acute care hospitals. The research was spearheaded by experts from the Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa; Department of Medicine, Maine Medical Center, Portland, Maine; and was backed by numerous esteemed organizations including the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America, and the Association of Professionals in Infection Control.

The research sought to uncover invaluable insight into the effectiveness of widely accepted infection prevention methods, focusing intently on the MRSA infection. With the advent of the COVID-19 pandemic, discussion and evaluation of infection prevention modalities have become imperative. However, this study distinguished itself by considering the perspectives and exposure risks of a myriad of healthcare professionals, including those from the peripheral fields like food, respiratory, physical, speech therapists, environmental services, and clinical dieticians.

The study drew a correlation between heightened exposure risk to SARS-CoV-2 and increased reporting of errors in adopting infection prevention strategies. This highlights the critical need to fortify training and policies regarding infection prevention, particularly amidst pandemics and situations of heightened stress. The study’s authors expressed reservations about the universal practice of using Contact Precautions (CP) for all patients colonized or infected with MRSA. This modality has long been considered a non-negotiable component of healthcare facilities.

However, the team argues that its universal usage lacks strong support from concrete evidence. There is an absence of controlled trials that explicitly attest to the effectiveness of CP in curbing MRSA transmission. The available observational studies fail to conclusively prove CP’s superiority over other preventive interventions such as standard precautions, hand hygiene, and environmental cleaning. While the decline in hospital-onset bloodstream infections from MRSA has been significant, it is crucial to note a global decrease in MRSA infections starting around 2005. This makes it challenging to attribute this positive trend solely to CP’s advent and widespread implementation.

Furthermore, the authors reflect on the successful MRSA prevention initiative by the US Department of Veterans Affairs (VA) health care system. It amalgamated several techniques, including active screening for MRSA, hand hygiene, and CP. Still, controlled studies evaluating the increased application of CP did not confirm its indisputable effectiveness. The authors underscore the environmental concerns linked with CP, primarily its reliance on single-use items like gowns and gloves made up of plastics.

As per estimates, these add to over 1.5 billion discards annually, leading to mounting environmental costs, carbon emissions, and harmful plastic release. The urged medical facilities to review their CP policy aligning it with the broader goals of reducing harm, waste, and environmental impact while prioritizing patient safety. The study ultimately advocates a more reasoned, context-specific strategy when it comes to the use of CP for MRSA prevention, suggesting that it’s used chiefly in select high-risk situations or when evidence delineates an ongoing transmission despite other preventive efforts in place.

Source: https://www.infectioncontroltoday.com/view/challenging-universality-contact-precautions-mrsa-prevention-critical-appraisal-recent-infection-control-guidelines

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