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Understanding the Changing Landscape of Contact Precautions in Infection Prevention

Vigilance and a scientific approach are the linchpins in preventing the transmission of infectious agents in healthcare environments. One such measure deployed by healthcare professionals is the application of contact precautions. These are designed to halt the spread of infectious agents through both direct and indirect contact within healthcare settings. However, it’s crucial to note that the efficacy of contact precautions in non-outbreak circumstances, particularly for pathogens like Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococci (VRE), is a topic of ongoing discussion and research.

The data supporting the use of contact precautions as a singular strategy in these situations are inconsistent. More often than not, studies suggest that when used as part of a broader, multifaceted approach to infection prevention, contact precautions significantly reduce MRSA and VRE transmissions. In contrast, the application of contact precautions as a standalone measure exhibits mixed results. Substantiating this stance, many prominent healthcare organisations do not employ contact precautions for MRSA and VRE, successfully preventing infections without this approach, indicating that benefits can be experienced when eschewing these precautions. However, professional bodies like the Society for Healthcare Epidemiology of America (SHEA), Infectious Diseases Society of America (IDSA), Association for Professionals in Infection Control and Epidemiology (APIC), and the Centers for Disease Control and Prevention (CDC) nonetheless continue to advocate for contact precautions as an essential practice, especially for multi-drug resistant organisms (MDROs), while allowing allowances for hospitals to modify the use of contact precautions under certain circumstances, mainly when robust horizontal prevention measures are in place. Across the country, numerous healthcare facilities have refrained from using contact precautions for MRSA and VRE, consistently maintaining low infection rates for extended periods.

These facilities also pointedly note the potential harms to patients that may stem from implementing contact precautions. Further, in such environments where contact precautions for MRSA and VRE are not applied, co-benefits like cost reductions and improved environmental sustainability are observed. It is pertinent to underline the evolving epidemiology of MRSA and VRE within healthcare systems, with several studies arguing against the effectiveness of contact precautions outside outbreak scenarios. This fact is underscored by our improved antibiotic arsenal against MRSA and VRE compared to when these pathogens were first identified.

As infection prevention professionals navigate this dynamic landscape, it is crucial to maintain a focus on leveraging horizontal Infection Prevention and Control (IPC) strategies, such as hand hygiene enhancement, while implementing changes. Future discussions and webinars, for instance, could delve into the importance of Chlorhexidine gluconate (CHG) bathing as part of horizontal IPC strategies. Specific patient cohorts, such as those in the Neonatal Intensive Care Unit (NICU), Hematology/Oncology, and Transplant departments, might continue to necessitate contact precautions. As we emphasize MRSA and VRE due to the novelty of discontinuing contact precautions for these organisms for many facilities, it is also crucial to discuss the application of standard precautions for Enterobacterales that produce Extended Spectrum Beta-Lactamases (ESBL). Like MRSA and VRE, substantial evidence supports the use of standard precautions for ESBL without significant impacts on patient or staff safety.

Source: http://publichealth.lacounty.gov/acd/RethinkingContactPrecautions/index.htm

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