Tuesday, December 18, 2012

Moving away from contact precautions

Yesterday, Dan posted on the new study by Dan Morgan and others at the University of Maryland that points out yet again that contact precautions have an impact on care received by inpatients. Over the past year or so, I began to wonder about scaling back contact precautions. My colleagues, Gonzalo Bearman and Mike Stevens, recently published a paper on considerations for reducing contact precautions. Our hand hygiene rates have been >90% institution-wide for 3 years and we conduct surveillance hospital-wide for all device-related infections. And we've continued to focus on horizontal infection prevention strategies, such as chlorhexidine bathing, which we do for all ICU patients, and more recently for non-ICU patients with devices in situ. Thus, it seemed as though it was time to bite the bullet. We are now rolling out a new policy in which MRSA and VRE infection and colonization no longer require contact precautions. We'll still continue contact precautions for multidrug resistant gram-negatives, C. difficile, and ectoparasitic infestations. Feedback from healthcare workers has been very positive. And I bet we'll also make some patients happy. It should also produce less waste--we currently use 1.3 million disposable plastic gowns yearly!

Photo: Stericycle

4 comments:

  1. Good luck Mike! Usually, we are hoping for changes in intercept or slope of the regression line after an infection prevention intervention. Here it will be fun to see no changes too. Thanks for walking us back from the cliff

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  2. First: HH rates >90% institution wide --> Wow!! My compliments! Second: could you explain to me why you still continue CP for MDGN such as ESBL?

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  3. We are continuing contact precautions for MDR-gram negative organisms because we have less understanding of their epidemiology.

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  4. Thanks for your reply. I was curious about your motivations because in our (Dutch) hospital, we are doing just the opposite :
    - patients with MDR GN are cared for in contact isolation (only a gown and gloves)
    - patients with MRSA are cared for in strict isolation (special isolation room, gown, gloves, cap and surgical mask).

    Please keep us (readers of your blog) informed about this interesting 'project' Kind regards Veronica Weterings

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