Researchers call for end to legal mandates for MRSA, VRE contact precautions

Editor's Note

Despite widespread adoption of contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), there is no strong clinical trial evidence to support the mandated use of these precautions, three noted infection prevention researchers say.

Without the support of evidence, policy makers from 2000 to 2010 passed laws mandating active culturing and contact precautions. Failure to follow the laws can result in sanctions by the department of health, fines, and even jail time.

The data, however, support a more selective use of contact precautions for the control of endemic pathogens, for patients with draining wounds or infectious diarrhea, or for high-risk patient care activities.

Hospitals should reconsider best use of contact precautions in the context of a broad approach to infection control targeting the highest value interventions, the researchers say.

It is time for the Centers for Disease Control and Prevention to update its 2007 guideline, and for legal mandates and metrics for active surveillance cultures to be  retired, they conclude.

Physical barriers have been used to prevent infectious diseases dating back to leather gloves and coats used during the Black Death in medieval Europe. In the United States, isolation of persons with infections coincided with the development of infectious disease hospitals during the 19th century and introduction of "barrier nursing" in 1910, which included the use of gowns for health care workers.