Researcher Explores Whether Contact Precautions Do More Harm Than Good

In an article, "Emerging Infections: The Contact Precautions Controversy" in the latest issue of the American Journal of Nursing, author Rachel L. Zastrow, BSN, a patient safety liaison at Central DuPage Hospital in Winfield, Ill. asserts that an automatic assignment of a patient into contact precautions -- which is more restrictive than standard precautions and often includes isolation -- may actually create more harm than benefit.

According to guidelines from the Centers for Disease Control and Prevention (CDC), standard precautions "include a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which health care is delivered." These include "hand hygiene; use of gloves, gown, mask, eye protection, or face shield, depending on the anticipated exposure; and safe injection practices." Zastrow explains that contact precautions "constitute one of three more stringent levels of transmission-based precautions," and that these "are used when the route(s) of transmission is (are) not completely interrupted using standard precautions alone." Under contact precautions, a gown and gloves are worn for 'all interactions that may involve contact with the patient or potentially contaminated areas in the patient's environment.' Personal protective equipment is put on upon room entry and discarded upon exiting; a private room for the patient is recommended."

As Zastrow emphasizes, "There are circumstances in which virtually all health care workers and experts would agree that contact precautions are necessary. For example, a patient with a MRSA-positive wound infection and purulent drainage should certainly be isolated and placed under contact precautions to prevent spread of the pathogen. An incontinent patient with VRE-associated urinary tract infection requires additional precautions as well. However, patients merely colonized, rather than infected, with these organisms represent a gray area. In many settings, the use of contact precautions in any colonized patient has been unquestioned; one might ask, however, whether there's any significant difference in infection risk between a patient with MRSA colonization and a patient colonized with methicillin-susceptible Staphylococcus aureus (MSSA)."

Reference: Zastrow RL. Emerging Infections: The Contact Precautions Controversy. Am J Nurs. March 2011. Volume 111, Issue 3. Pp 47-53.