Wednesday, August 3, 2011

Contact precautions, and why I hate them, entry number next

Regular readers of this blog know that we’ve raised many questions about contact precautions (CP). We have very few arrows in our quiver to fight multiple-drug resistant organisms (MDROs). CP is one of them. So naturally it has become infection prevention dogma that CP is necessary to control MDRO spread. Never mind that the effectiveness of CP has really only been demonstrated in outbreak settings, that adherence to CP is often terrible, and that CP likely has several nasty unintended consequences that can harm patients. The bottom line? We desperately need more research, both to address the effectiveness of CP at preventing pathogen transmission, and to address the potential unintended consequences of widespread application of CP.

Regarding the latter (unintended consequences), we have two recent additions to the literature courtesy of Eli and his homeys back in Maryland. The first study, led by Dan Morgan, examines the relationship between CP and adherence to several quality-of-care process measures (e.g. SCIP, pneumonia, CHF, acute MI), and the second study, led by Hannah Day, examines the relationship between CP and depression among acute care inpatients.

I have an obvious conflict of interest and will therefore not critique either study. Instead I will leave it to you, dear reader, to assess their quality and to leave any comments, positive or negative, that you wish.

1 comment:

  1. I agree, it’s very unclear that following something like, “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings”, makes sense in all cases, resulting in greater benefit than harm. It will be nice to have a stronger body of evidence for when it is beneficial to use CP, especially since iatrogenic artifacts of CP, rarely include the environment at large.