And another reason to hate contact precautions...
There's a new paper in the Journal of Trauma and Acute Care Surgery that adds to the concern regarding the safety of contact precautions. This retrospective two-year study evaluated approximately 4,400 trauma patients and compared the incidence of venous thromboembolism [VTE] (as detected by active surveillance via duplex ultrasound) in patients who were isolated versus those who were not. I should note that there is an error in the title of the paper as isolated patients also included those on droplet and airborne precautions. However, in most hospitals contact precautions account for the vast majority of patients who are isolated, and even more so in the hospital studied since they performed active microbiologic surveillance for MRSA via PCR. VTE occurred in 17.7% of the isolated patients and 3.5% of the non-isolated patients. After controlling for a number of confounders, isolation remained an independent predictor of VTE (odds ratio 2.6, CI95 1.7-4.0).
Increasingly, hospitals are scaling back contact precautions for MRSA and VRE, and with good reason!
Something fishy here. Can't quite put my finger on it (only able to read abstract too), but in the age of DVT prophylaxis, both rates of VTE seem high and 18% is really high. Not convinced that their adjustment models could account for the baseline differences between these two populations. I also feel most of what we blame on contact precautions exists in the literature because of publication bias - people only publish positive studies, especially of they are single center, non-RCTs. To be honest, the same publication bias skews the benefits of contact precautions literature too. Thus, the way we view and review the contact precautions literature says more about ideology than actual science.
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