Does high adherence to contact precautions lead to low in-hospital transmission of multidrug-resistant microorganisms in the endemic setting?

J Hosp Infect. 2021 Jul 9:S0195-6701(21)00263-2. doi: 10.1016/j.jhin.2021.07.002. Online ahead of print.


BACKGROUND: Conflicting results have been published on the impact of contact precautions (CP) on reduction of transmission of multidrug-resistant microorganisms (MDROs) in the endemic setting. Ambiguous definitions coupled with low adherence partly explain these differences.

AIM: We prospectively monitored the level of adherence to CP and aimed to relate it to in-hospital transmission of MDROs.

METHODS: Between 1/2016-3/2018, all patients under CP underwent continuous monitoring of adherence to CP by routine on-site visits on day 0, 3 and 7 after initiating CP using a standardized checklist. The protocol included ten interventions that were routinely checked such as CP sign at the door as well as wearing gowns and gloves upon entry to the patient room. Patients requiring CP were defined as colonized or infected with MDROs (methicillin-resistant Staphylococcus aureus [MRSA], non-Escherichia coli ESBL-Enterobacterales, vancomycin-resistant enterococci [VRE] and carbapenem-resistant Gram-negative microorganisms [CRGN]) as well as patients infected with respiratory viruses, norovirus, scabies and hypervirulent strains of Clostridioides difficile.

FINDINGS: Overall, data from 13,756 CP records from 1,378 visits of 812 patients were analyzed. Adherence varied between 93-100% for each intervention, except for "separate space for contaminated material" with an adherence of 5.3-6.1%. The incidence of in-hospital transmission during the study period was extremely low for MRSA, VRE, non-E.coli ESBL-Enterobacterales and CRGN with 0.00-0.064 cases/1,000 patient days.

CONCLUSION: High adherence coupled with continuous monitoring of CP correlated to a very low in-hospital transmission rate. These results indicate that CP is highly effective if routine monitoring of adherence is implemented.

PMID:34252477 | DOI:10.1016/j.jhin.2021.07.002