Are Contact Precautions “Essential” for the Prevention of Healthcare-associated Methicillin-Resistant Staphylococcus aureus?

Abstract

The recently updated SHEA/IDSA/APIC practice recommendations for MRSA prevention in acute care facilities list contact precautions (CP) for patients known to be infected or colonized with MRSA as an “essential practice”, meaning that it should be adopted in all acute care facilities. We argue that existing evidence on benefits and harms associated with CP do not justify this recommendation. There are no controlled trials that support broad use of CP for MRSA prevention. Data from hospitals that have discontinued CP for MRSA have found no impact on MRSA acquisition or infection. The burden and harms of CP remain concerning, including the environmental impact of increased gown and glove use. We suggest that CP be included among other “additional approaches” to MRSA prevention that can be implemented under specific circumstances (e.g. outbreaks, evidence of ongoing transmission despite application of essential practices).

Prevalence and factors associated with methicillin-resistant Staphylococcus aureus colonization on admission to geriatric care units: impact on screening practices

“…38 In particular, the environmental impact of the increased use of gowns and gloves, the effectiveness of which has yet to be demonstrated for MRSA. 14 According to the recommendations of the Society for Healthcare Epidemiology of America/Centers for Disease Control, active surveillance of MRSA on a hospital-wide scale can be used in conjunction with contact precautions to reduce the incidence of MRSA infection with moderate-quality evidence. 3 However, the reduction of MRSA transmission to other patients in the ward depends on a set of measures that must be taken into account to assess the benefits and drawbacks of a targeted screening protocol with a decreased loss of sensitivity and specificity.…”

“…At this time, there is currently no international consensus on screening patients for MRSA upon admission. A recent study indicated that some acute care facilities have reported no negative consequences associated with discontinuing contact precautions for patients colonised with MRSA 14 . In addition, screening recommendations do not take into account the specificities of the geriatric population, despite the documented increased risk of infection and carriage in this type of patient.…”

Research agenda for transmission prevention within the Veterans Health Administration, 2024–2028

“…12 It is worth mentioning that there remains active discussion about the necessity of universal CP for MRSA. 28,29 This controversy primarily arises from inadequate data as well as the difficulty in separating the effect of CP alone from other interventions often bundled with CP (eg, hand hygiene). 30 Due to the relatively rare detected transmission of MDRO organisms, large sample sizes are needed over long periods to optimally measure effectiveness, 31,32 and modeling is often used as an adjunct to study transmission.…”

“…Data continues to emerge about the psychological aspects of patient isolation, 36 though trial data suggests that CP has minimal impact on non-infectious adverse events. 37 Another non-infectious adverse event of increasing relevance is the environmental impact of contact precautions 29,38 this is an under-explored topic and research is needed to quantify the environmental impact of different CP scenarios (eg, universal vs targeted CP), and future modeling work should ideally incorporate environmental sustainability metrics (eg, carbon footprint, plastic waste burden) into cost-effectiveness models.…”

“…Sharma (2020) 36 Contact precautions generate healthcare waste, yet little has been done to evaluate the environmental impact of CP and how it affects decision-making about when to utilize CP Diekema (2023) 29 Develop estimates of waste and carbon emissions for various CP-use scenarios (eg, by setting, type of organism, and bundle). Future cost-effectiveness modeling for CP should incorporate environmental impact such as carbon footprint and plastic waste generation.…”