Written by Clay Smith
Contact precaution (CP) for patients with MRSA infection or colonization is listed as an “essential practice” for all U.S. hospitals, but should it be?
Take caution with precautions
This is a critique of the SHEA/IDSA/APIC compendium on MRSA transmission in hospitals. Authors argue that CP has a role in MRSA prevention but should not be listed as an “essential practice” in a guideline that likely won’t be updated for another 10 years.
Key critiques are:
- Although studies of environmental/personnel contamination with use of CP are biologically plausible, there is no evidence CP is better than standard precautions, good hand hygiene, and usual cleaning.
- Observational studies are unclear and both support and refute the efficacy CP for MRSA prevention.
- Even cluster randomized controlled trials, that incorporated CP among other interventions, found no impact of CP beyond other measures, like hand hygiene or chlorhexidine/mupirocin decolonization.
But what’s the harm?
- Patients on CP have fewer interactions with their healthcare team.
- CP is associated with longer length of stay, higher costs, and higher readmission rates.
- PPE fatigue is real, negatively impacts personnel morale, and may decrease compliance with CP when caring for patients with more compelling indications for its use.
- CP can lead to bed management problems and longer ED lengths of stay.
- There is a negative environmental impact. Universal CP for MRSA in U.S. hospitals would use, “more than 1.5 billion gowns and gloves annually.” That is, “576,000 metric tons of carbon dioxide emissions.”
How will this change my practice?
Standard precautions and meticulous hand hygiene are highly effective. I’m not opposed to CP, but I agree it should not be listed as essential. I also hadn’t considered the downsides to CP.
Are contact precautions “essential” for the prevention of healthcare-associated methicillin-resistant Staphylococcus aureus? Clin Infect Dis. 2023 Sep 21:ciad571. doi: 10.1093/cid/ciad571. Online ahead of print.