Tuesday, December 18, 2012

Contact Precautions: Benefits Revisited

It seems like the topic of contact precautions is receiving ongoing attention in the hospital epidemiology literature. The current trend of articles tend to question the benefits of contact precautions and underscore its untoward consequences.

The latest study, published in Infection Control and Hospital Epidemiology, examines the effects of contact precautions on healthcare worker (HCW) activity in acute care hospitals. Using a prospective observational design, a total of 7,743 HCW visits were observed over 1,989 hours. Patients on contact precautions had 36.4% fewer hourly HCW visits than patients not on contact precautions as well as 17.7% less direct patient contact time with HCWs. In addition, patients on contact precautions tended to have fewer visitors 23.6% fewer. HCWs were more likely to perform hand hygiene on exiting the room of a patient on contact precautions (63.2% vs 47.4% in rooms of patients not on contact precautions).

Less than 10 years ago, active detection and isolation for MRSA was all the rage in hospital epidemiology. Times are changing as we learn the potential negative impact of isolation precautions.

An excellent related blog from my colleagues in Controversies in Hospital Infection Prevention can be found here.

We feel it is time to rethink contact precautions for the control of endemic pathogens. By using robust, horizontal infection prevention measures, endemic pathogens such as MRSA and VRE may be effectively controlled without employing contact precautions.

Stay tuned.

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