Wednesday, June 28, 2017

Good Enough! Seeking Solutions in the Infection Prevention World

I have heard criticism that our perspective on contact precautions, particularly the discontinuation of contact precautions for MRSA and VRE, is based on scant evidence and is thus not valid. To date, there is little data to support or reject the efficacy of contact precautions for the control of endemic MRSA and VRE, as we published in this thorough review.

It is important not to become fixated on a paradigm so as to lose our ability to question and shift perspective. We should also avoid methodolatry (the profane worship of clinic trials as the only valid trial of investigation).

In the absence of high quality evidence and when high quality, multi-center, cluster-randomized trials to assess the efficacy of contact precautions for endemic MRSA and VRE will likely never materialize (no one will fund it), we must be pragmatic and search for solutions that satisfice in the real world, ones that are good enough.

I believe in primum non-nocere and pragmatism. If discontinuing contact precautions for endemic MRSA and VRE is coupled with a high reliability, horizontal infection prevention program and no increase/declining MRSA, VRE and hospital acquired infections (no harm), then a shift in practice is not unreasonable.

Contact precautions for the control of MRSA and VRE should not be dogmatic and should be used based on institutional assessment and need.

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