Program Schedule

310
Routine Use of Contact Precautions for MRSA and VRE:  Which Way is the Pendulum Swinging?

Session: Poster Abstract Session: MRSA and VRE
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • ID Week 2014 MRSA and VRE Poster_FINAL VERSION Sept 2014.pdf (847.3 kB)
  • Background: Contact Precautions (CP) for preventing transmission of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) has been a cornerstone of infection prevention programs.  In recent years, however, horizontal interventions such as chlorhexidine gluconate (CHG) bathing and ultraviolet-C (UVC) light disinfection have gained traction, and studies have increasingly suggested that CP may have risks that outweigh its benefits. This study was conducted to assess the present state of CP in U.S. hospitals.

    Methods: 751 physician members of the Emerging Infections Network (EIN) who had identified themselves as having interest or involvement in infection prevention/infection control were invited to complete an electronic survey.  The survey, which remained open for 4 weeks, contained 8 questions designed to ascertain current practices related to reducing transmission of MRSA and VRE.  

    Results: 429 members responded to the survey (57.7%). Respondents reported ongoing use of routine CP for MRSA (93%) and VRE (92%).  The most widely used trigger for CP for both pathogens was positive clinical culture (97%), followed by pre-existing alert in the electronic record (90%), then positive surveillance culture (76%); practices for discontinuation of isolation varied widely.  81% reported performing MRSA active surveillance testing (AST) and 34% perform VRE AST for specific inpatient populations. 85% perform CHG bathing and 64% perform S. aureus decolonization with mupirocin for one or more subsets of inpatients.  23% reported using either hydrogen peroxide vapor or UVC light as means of room disinfection at discharge. Free text responses noted frustration and heterogeneity in the application, practice, and discontinuation of CP.  

    Conclusion: Routine use of CP for MRSA and VRE remains commonplace, although horizontal interventions such as CHG bathing are increasingly used. Respondents frequently questioned the value of routine CP. The heterogeneity of practices & policies was striking, and may be guided by regulatory pressure. Evidence-based guidelines from professional organizations regarding CP and horizontal interventions are needed.

    Dana Russell, MPH1, Susan E. Beekmann, RN, MPH2, Philip M. Polgreen, MD2, Zachary Rubin, MD3 and Daniel Z. Uslan, MD, MS3, (1)Clinical Epidemiology and Infection Prevention, UCLA Health, Los Angeles, CA, (2)Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, (3)Infectious Diseases, David Geffen School of Medicine/University of California, Los Angeles, Los Angeles, CA

    Disclosures:

    D. Russell, None

    S. E. Beekmann, None

    P. M. Polgreen, None

    Z. Rubin, None

    D. Z. Uslan, None

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