Evaluation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus

Bardossy, Ana C.; Alsafadi, Muhammad Yasser; Starr, Patricia; Chami, Eman; Pietsch, Jennifer; Moreno, Daniela; Johnson, Laura E.; Alangaden, George; Zervos, Marcus J.; Reyes, Katherine

doi:10.1016/j.ajic.2017.06.017

Cited by 26 publications

(22 citation statements)

References 10 publications

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“…Bardossy et al investigated the effect of discontinuation CP in a retrospective study in an 800 bed teaching hospital. There were no significant differences in infection rates with MRSA and VRE catheter-associated urinary tract infections, ventilator-associated pneumonia, central-line associated bloodstream infections, surgical site infections and hospital-acquired MRSA bacteremia during the two 12-month periods including more than 76,000 patients [ 16 ]. However, asymptomatic transmission of MRSA and VRE were not investigated by routine screening.…”

Section: Preventative Strategiesmentioning

confidence: 99%

Antibiotic stewardship and horizontal infection control are more effective than screening, isolation and eradication

Lemmen

Lewalter

2018

Infection

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PurposeThe global rise of multidrug resistant organisms (MDROs) is of major concern since infections by these pathogens are difficult, and in some cases, even impossible to treat. This review will discuss the effectiveness of a pathogen-independent alternative approach consisting of the implementation of antibiotic stewardship (ABS) programs, improvement of hand hygiene compliance, and daily antiseptic body washings instead of “screening, isolation and eradication” as recommended by many infection control guidelines today.MethodsA review of the literature.ResultsThe classical approach composed of screening, isolation and eradication has many limitations, including lack of standardization of the screening methods, risk of medical errors for patients in isolation and failure to eradicate resistant bacteria. Notably, concrete evidence that this current infection control approach actually prevents transmission is still lacking. We found that a novel approach with the training of infectious diseases specialists can reduce the usage of antimicrobials, thereby significantly decreasing the emergence of new MDROs. Moreover, increased hand hygiene compliance not only reduces transmission of MDROs, but also that of sensitive organisms causing the majority of nosocomial infections. Further, instruments, such as continuing education, bed-side observation, and the use of new tools, e.g. electronic wearables and Wi-Fi-equipped dispensers, are all options that can also improve the current low hand hygiene compliance levels. In addition, daily antiseptic body washes were observed to reduce the transmission of MDROs, especially those deriving from the body surface-like MRSA and VRE in specific settings. Finally, antiseptic body washes were seen to have similar effects on reducing transmission rates as screening and isolation measures.ConclusionsIn summary, this review describes a novel evidence-based approach to counteract the growing medical challenge of increasing numbers of MDROs.

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Section: Preventative Strategiesmentioning

confidence: 99%

Antibiotic stewardship and horizontal infection control are more effective than screening, isolation and eradication

Lemmen

Lewalter

2018

Infection

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“…Currently, contact precautions as an infection prevention policy is controversial, with some arguing for discontinuing its use in specific settings and organisms. [9][10][11]20 However, as others have noted, 12 there remain significant unanswered questions on safety and the effect on transmission rates of discontinuing contact precautions. The PPE-free zone, which does not appear to have any negative effect on HCP compliance with contact precautions or entry hand hygiene, may be a viable approach for reducing HCP burden while maintaining contact precautions use until the controversy is better studied and resolved.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, this implementation of the PPE-free zone is the first large-scale, multifacility study testing the effectiveness of the PPE-free zone. Currently, contact precautions as an infection prevention policy is controversial, with some arguing for discontinuing its use in specific settings and organisms 9 – 11 , 20 . However, as others have noted, 12 there remain significant unanswered questions on safety and the effect on transmission rates of discontinuing contact precautions.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] As a result, some facilities have discontinued the use of contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycinresistant Enterococcus. [9][10][11] However, there is limited evidence to-date demonstrating that the elimination of contact precautions is safe. 12 In light of these challenges, strategies termed "safe zones" or "red box" have been proposed that require PPE use only during higher-risk encounters with patients on contact precautions.…”

mentioning

confidence: 99%

“…In addition to low levels of fully compliant PPE use, 5 significantly fewer visits are made to patients on contact precautions 6 – 8 . As a result, some facilities have discontinued the use of contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus 9 – 11 . However, there is limited evidence to-date demonstrating that the elimination of contact precautions is safe 12 …”

mentioning

confidence: 99%

See 2 more Smart Citations

Effectiveness of a multisite personal protective equipment (PPE)–free zone intervention in acute care

Visnovsky

Zhang

Leecaster

et al. 2019

Infect. Control Hosp. Epidemiol.

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Objective:Determine the effectiveness of a personal protective equipment (PPE)-free zone intervention on healthcare personnel (HCP) entry hand hygiene (HH) and PPE donning compliance in rooms of patients in contact precautions.Design:Quasi-experimental, multicenter intervention, before-and-after study with concurrent controls.Setting:All patient rooms on contact precautions on 16 units (5 medical-surgical, 6 intensive care, 5 specialty care units) at 3 acute-care facilities (2 academic medical centers, 1 Veterans Affairs hospital). Observations of PPE donning and entry HH compliance by HCP were conducted during both study phases. Surveys of HCP perceptions of the PPE-free zone were distributed in both study phases.Intervention:A PPE-free zone, where a low-risk area inside door thresholds of contact precautions rooms was demarcated by red tape on the floor. Inside this area, HCP were not required to wear PPE.Results:We observed 3,970 room entries. HH compliance did not change between study phases among intervention units (relative risk [RR], 0.92; P = .29) and declined in control units (RR, 0.70; P = .005); however, the PPE-free zone did not significantly affect compliance (P = .07). The PPE-free zone effect on HH was significant only for rooms on enteric precautions (P = .008). PPE use was not significantly different before versus after the intervention (P = .15). HCP perceived the zone positively; 65% agreed that it facilitated communication and 66.8% agreed that it permitted checking on patients more frequently.Conclusions:HCP viewed the PPE-free zone favorably and it did not adversely affect PPE or HH compliance. Future infection prevention interventions should consider the complex sociotechnical system factors influencing behavior change.

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Multidrug-Resistant Organisms: Pre-transplant Evaluation and Management

Nellore¹,

Lee²

2020

Emerging Transplant Infections

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Evaluation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus

Cited by 26 publications

References 10 publications

Antibiotic stewardship and horizontal infection control are more effective than screening, isolation and eradication

Antibiotic stewardship and horizontal infection control are more effective than screening, isolation and eradication

Effectiveness of a multisite personal protective equipment (PPE)–free zone intervention in acute care

Multidrug-Resistant Organisms: Pre-transplant Evaluation and Management

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