Q&A: Are contact precautions essential for MRSA prevention?

Source/Disclosures

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Disclosures:
Diekema reports receiving grant funding from bioMerieux, Inc. and consulting fees from OpGen, Inc. Please see the study for all other authors’ relevant financial disclosures.

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Key takeaways:

• Recent recommendations for MRSA prevention suggest contact precautions are essential.
• There are currently no controlled trials supporting the broad use of contact precautions for MRSA prevention.

Updated recommendations for MRSA prevention in acute-care facilities suggest contact precautions for patients known to be infected are “essential,” although researchers argue data do not justify the recommendation.

In a recent paper, Daniel J. Diekema, MD, D(ABMM), professor at the University of Iowa Carver College of Medicine and vice chair of research at the Maine Medical Center’s department of medicine, and colleagues wrote that there are currently no controlled trials supporting the broad use of contact precautions for MRSA prevention.

Healio spoke with Diekema further to discuss what the data do show, what changes could be made to recommendations and if contact precautions are essential.

Healio: What prompted this paper?

Diekema: The recent publication of the Society for Healthcare Epidemiology of America (SHEA)/Association for Professionals in Infection Control and Epidemiology (APIC)/Infectious Diseases Society of America (IDSA) compendium of strategies to reduce MRSA infection is what prompted us to write this.

The compendium listed contact precautions as an “essential practice” for MRSA prevention. We feel that the current state of the evidence does not support this conclusion; furthermore, an increasing number of hospitals are safely deimplementing contact precautions for MRSA carriers. So we want to provide a different perspective on the evidence.

Healio: What are the current recommendations in terms of contact precautions?

Diekema: Contact precautions are recommended by the CDC as one practice that may help reduce the risk of MRSA transmission in health care settings.

Healio: What do the data show?

Diekema: Our paper reviews the data, finding that observational studies are inconclusive — they come to different conclusions about contact precautions (some support its use for MRSA carriers, others do not). The randomized trials that have included expansion of contact precautions find that it has little-to-no impact on MRSA acquisition or infection when compared with other strategies that do not use contact precautions — for example, improved hand hygiene or use of chlorhexidine bathing.

Healio: What changes do you suggest should be made?

Diekema: We argue that contact precautions should be considered an “additional practice,” one that may be useful under some circumstances, but may not be necessary at all hospitals.

Healio: Are contact precautions “essential?”

Diekema: We don’t believe the current level of evidence suggests they are “essential” — quite the opposite. But we also agree that additional studies should be performed to better determine when contact precautions ought to be implemented, not only for MRSA carriers but for other microbial threats.

For example, do we still need to use contact precautions for SARS-CoV-2, which has an airborne route of transmission and for which contact (touch) transmission is much less common? We still know far too little about how and when to apply different types of transmission-based precautions. Improved funding for this type of very practical research would pay huge dividends for patient safety.