Contact precautions are a set of safeguards used by healthcare personnel to prevent the transmission of infectious agents. Contact precautions target infectious agents that are transmitted by direct and indirect contact with the healthcare environment.

Contact precautions include the following:

• Patient placement
• Use of Personal Protective Equipment (PPE), usually disposable gown and gloves
• Limit patient transport and movement
• Use of disposable or dedicated equipment
• Cleaning and disinfection

Epidemiologically important pathogens can:

• Result in high morbidity or mortality
  • E.g., Ebola, gram negative rods
• Be resistant to antibiotics or antifungals
  • E.g., Carbapenem-resistant Enterobacterales (CRE), Carbapenem-Resistant Acinetobacter baumannii (CRAB), Carbapenem-Resistant Pseudomonas aeruginosa (CRPA)

Data supporting the use of contact precautions as a way of preventing MRSA and VRE transmission in non-outbreak healthcare settings are mixed. Frequently, studies have shown that MRSA/VRE contact precautions are effective at reducing infections only as part of a multifaceted approach to reducing transmission, rather than as a standalone intervention. Years of experience from large healthcare organizations that do not use contact precautions for these organisms suggest that infections from MRSA and VRE can be successfully prevented without the use of contact precautions.

Hospitals that do not use contact precautions for MRSA and VRE stand to gain the following benefits:

• Financial savings: As a county, we spend >$7 million per year on gowns for MRSA/VRE contact precautions in L.A. On top of the material cost, donning, doffing, restocking, and disposing of gowns requires healthcare worker time which also has significant costs. Hospitals that discontinued MRSA/VRE contact precautions have demonstrated savings of ~$350,000 per year.
• Environmental sustainability: Single-use gowns for MRSA/VRE contact precautions generate close to 300,000kg of solid waste yearly in LA County. Manufacture and disposal of these gowns is estimated to create the same amount of greenhouse gas emissions as 5.8 million miles driven in a typical passenger car.
• Faster transitions of care: Patients in contact precautions who need long-term care can have their hospitalization prolonged by close to a week compared to patients not in contact precautions. Similarly, contact precautions often cause emergency room delays for patients: emergency department admission times dropped by >2 hours for MRSA and VRE patients in hospitals that stopped contact precautions for these organisms.

The Society for Healthcare Epidemiology of America (SHEA)/Infectious Diseases Society of America (IDSA)/Association for Professionals in Infection Control and Epidemiology (APIC) Practice Recommendation: “Although contact precautions remain an essential practice, considerations have been provided for hospitals that have strong horizontal prevention measures and neither ongoing MRSA outbreaks nor high or increasing rates of MRSA infection or hospital-onset MRSA-positive cultures and that choose to modify the use of contact precautions for some or all MRSA-colonized or MRSA-infected patients.”

CDC guidance on Multidrug-resistant organisms (MDROs): “MDROs judged by the infection control program, based on local, state, regional or national recommendations, to be of clinical and epidemiological significance. Contact precautions recommended in settings with evidence of ongoing transmission, acute care settings with increased risk for transmission or wounds that cannot be contained by dressings…”

The Joint Commission expectation: “When developing infection prevention and control activities, the organization uses evidence-based national guidelines or, in the absence of such guidelines, expert consensus.” – IC.01.05.01 EP 1

• Perform a risk assessment in your facility:
  • Consider the opportunity for MRSA and VRE transmission.
  • Consider facility-specific MRSA AND VRE burden.
• Perform an Infection Prevention and Control (IPC) gap analysis:
  • Identify practice shortcomings.
  • Implement IPC improvements.
• Identify high risk situations where contact precautions may still be appropriate. A few examples include:
  • Neonatal Intensive Care Unit (NICU) for all Staphylococcus aureus (S. aureus).
  • Heme/oncology.
  • Outbreaks.
• Implement new horizontal IPC practices.
• Educate staff on IPC changes.
• Consider discontinuation of contact precautions for MRSA and VRE and use standard precautions instead.