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Barrier Precautions in the Era of Multidrug Pathogens.

Authors
  • Pryor, Rachel1
  • Viola-Luqa, Carli1
  • Hess, Olivia1
  • Bearman, Gonzalo1
  • 1 Hospital Infection Prevention Program, Virginia Commonwealth University Health System, Richmond, VA USA.
Type
Published Article
Journal
Current treatment options in infectious diseases
Publication Date
Jun 29, 2020
Pages
1–11
Identifiers
DOI: 10.1007/s40506-020-00230-9
PMID: 32837337
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

There is a continuing debate regarding contact precaution (CP) usage for endemic multidrug-resistant organisms (MDROs). In this review, we examine current recommendations for CP and highlight differences in CP use between endemic and non-endemic MDROs. The discontinuation of CP had no effect on the incidence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci. The evidence regarding CP for extended-spectrum beta-lactamase producing Enterobacteriaceae is inconclusive, highlighting the need for more research to determine best infection control strategies. Carbapenem-resistant Enterobacteriaceae maintains a sporadic pattern in the USA, supporting current recommendations to use CP for colonized and infected patients. MDR Acinetobacter baumannii (MDR-AB) is extremely virulent and responsible for outbreaks in healthcare settings, emphasizing the need for CP use with MDR-AB infected patients. Candida auris (C. auris) is often misdiagnosed; it is resistant to UV light and quaternary ammonium low-level disinfection. Because little is known about the transmission of C. auris, significant caution and CP use are necessitated. There is little research on vancomycin-resistant S. aureus (VRSA) control strategies due to its rarity; thus, CP is strongly recommended. Contact precautions are frequently part of a bundled infection control approach that involves meticulous hand hygiene, patient decolonization, chlorhexidine gluconate bathing, and reducing the use of invasive devices. Healthcare facilities should continue to utilize CP for non-endemic MDROs and the presence of endemic MDROs; however, CP may not add benefit to the current infection prevention bundle approach. © Springer Science+Business Media, LLC, part of Springer Nature 2020.

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