Blog | Monday, November 4, 2013

A good time to ditch contact precautions?


I get that no one likes to don gowns and gloves before seeing patients, particularly infectious disease consultants who see a large number of patients colonized/infected with multi-drug resistant organizsms (MDRO). I understand that touching is important for healing and that somehow wearing gloves impedes the healing touch. I even see why some still think that contact precautions place patients at greater risk for medical errors, even if the data supporting that contention is lacking. What I don’t get is why infection prevention folks are pillorying one of the most effective methods we have in MDRO transmission prevention right when we need it the most.

My thoughts:
1) MDRO rates, particularly for Gram-negative pathogens like carbapenem-resistant Enterobacteriaceae and Acinetobacter are increasing.
2) We have no antibiotics in our quiver, so prevention is our only hope for a decade or more.
3) Most prior room occupant studies are flawed and when proper methods are used, prior room occupants are not a risk factor, thus the environment isn’t the only answer.
4) Hand hygiene compliance is only 60%. I know some are claiming 90% or more on their reports, but it’s simply not true.
5) Gloves are massively effective in reducing the burden of organisms on hands and contact precautions have now been shown to be effective in a randomized, controlled trial (if you can look past the JAMA trial nihilists).

Which brings me to the table below modified from a study we completed a few years ago. When a healthcare worker enters an A. baumannii+ patient’s room, 15% of the time they will leave the room with A. baumannii on their hands. If the hospital practices universal contact precautions, it will be 3% of the time.

So, I get why people hate contact precautions, particularly infectious disease-trained hospital epidemiologists. I just don’t get the delight with which they limit their use, given that contact precautions are supported by the strongest evidence that our dismal science can muster. I suspect, again, that I won’t have to live that long to witness their regret.

Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands). This post originally appeared at the blog Controversies in Hospital Infection Prevention.