Contact Precautions: When to Stop.

Infection Prevention

When is it safe for hospitals to discontinue contact precautions – gloves, gowns, masks, etc. – for patients with multidrug-resistant bacteria? The Society for Healthcare Epidemiology of America published new guidance on the topic in January, in Infection Control and Hospital Epidemiology.

“Because of the virulent nature of multidrug-resistant infections and C. difficile infections, hospitals should consider establishing policies on the duration of contact precautions to safely care for patients and prevent spread of these bacteria,” said David Banach, M.D., MPH, an author of the study, and hospital epidemiologist at University of Connecticut Health Center. “Unfortunately, current guidelines on contact precautions are incomplete in describing how long these protocols should be maintained.”

According to the guidance document, hospital personnel should weigh how much time has elapsed since the last positive culture to determine if contact transmission is likely. The guidance also advises on patient characteristics that could determine the duration of care.

For Clostridium difficile infections (CDIs) specifically, the recommendation is to continue contact precautions for at least 48 hours after the resolution of diarrhea, and to consider extending if CDI rates are elevated despite infection prevention and control measures.

Insufficient evidence exists to make a formal recommendation on whether patients with CDI should be placed on contact precautions if readmitted to the hospital, according to SHEA.

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