Search, Destroy, and Confirm: How to Maximize the Benefit and Reduce the Unintended Consequences of Contact Precautions for Control of Methicillin-Resistant Staphylococcus aureus
Clinical Infectious Diseases July 15, 2013 V.57 N.2 P.185-187
David A. Pegues
Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
Methicillin-resistant Staphylococcus aureus (MRSA) remains a leading cause of healthcare-associated infections despite longstanding efforts to limit transmission in acute care facilities. Although the burden of community-acquired MRSA continues to increase, up to 85% of MRSA infections are associated with healthcare settings, and MRSA infections result in an estimated quarter-million hospitalizations and >10 000 deaths per year [1, 2]. Strategies to limit the risk of MRSA acquisition in healthcare facilities include the use of barrier precautions, hand hygiene, active surveillance cultures, decolonization, bundles, and enhanced environmental cleaning . Evidence from systematic reviews shows that interventions that include isolation precautions can achieve major reductions in MRSA burden, even when MRSA is endemic . Although questions remain about the optimal approaches to MRSA control, most acute care hospitals continue to isolate patients with MRSA from clinical or surveillance cultures using contact precautions, including gowns, gloves, and private room or cohorting with another patient with MRSA, for the duration of the incident and subsequent hospital admissions.
The primary benefit of contact precautions is to limit the risk of transmission of MRSA and other multidrug-resistant organisms to other patients, although the resulting improved compliance with hand hygiene and the use of barrier precautions have the potential to decrease the risk that a MRSA-colonized patient will develop subsequent …