Barrier Precautions in the Era of Multidrug Pathogens
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Treatment and Prevention of Hospital Infections (D Vilar-Compte, Section Editor)
Barrier Precautions in the Era of Multidrug Pathogens Rachel Pryor, RN, MPH* Carli Viola-Luqa, RN, MSN, OCN Olivia Hess Gonzalo Bearman, MD, MPH Address * Hospital Infection Prevention Program, Virginia Commonwealth University Health System, Richmond, VA, USA Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Treatment and Prevention of Hospital Infections Keywords Contact precautions I MDROs I High-quality CP I Endemic I Controversy
Abstract Purpose of review There is a continuing debate regarding contact precaution (CP) usage for endemic multidrug-resistant organisms (MDROs). In this review, we examine current recommendations for CP and highlight differences in CP use between endemic and nonendemic MDROs. Recent findings The discontinuation of CP had no effect on the incidence of methicillinresistant Staphylococcus aureus and vancomycin-resistant Enterococci. The evidence regarding CP for extended-spectrum beta-lactamase producing Enterobacteriaceae is inconclusive, highlighting the need for more research to determine best infection control strategies. Carbapenem-resistant Enterobacteriaceae maintains a sporadic pattern in the USA, supporting current recommendations to use CP for colonized and infected patients. MDR Acinetobacter baumannii (MDR-AB) is extremely virulent and responsible for outbreaks in healthcare settings, emphasizing the need for CP use with MDR-AB infected patients. Candida auris (C. auris) is often misdiagnosed; it is resistant to UV light and quaternary ammonium low-level disinfection. Because little is known about the transmission of C. auris, significant caution and CP use are necessitated. There is little research on vancomycin-resistant S. aureus (VRSA) control strategies due to its rarity; thus, CP is strongly recommended. Summary Contact precautions are frequently part of a bundled infection control approach that involves meticulous hand hygiene, patient decolonization, chlorhexidine gluconate bathing, and reducing the use of invasive devices. Healthcare facilities should continue to utilize CP for non-endemic MDROs and the presence of endemic MDROs; however, CP may not add benefit to the current infection prevention bundle approach.
Treatment and Prevention of Hospital Infections (D Vilar-Compte, Section Editor)
Introduction Multidrug-resistant organisms (MDROs) are an emerging threat to patient safety in modern healthcare [1]. The incidence of multidrug-resistant organisms is increasing and outpacing the development of new antibiotic therapies. In the 1970s, contact precautions were employed for the prevention of MDROs in
healthcare setting. Most hospitals continue to employ policies that uphold this tenet of infection prevention. We explore the use of contact precautions for MDROs, with a focus on endemic versus emerging pathogens of epidemiologic significance.
Endemic multidrug-resistant organi
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