Targeted vs Standard Contact Precautions and Transmission of Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococci in Critically Ill Adults

Background: Contact precautions are used commonly to prevent nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE). Whether targeted contact precautions are as effective at preventing nosocomial infection as contact precautions for all patients with MRSA and VRE is uncertain. Research Question: Compared with standard contact precautions, are targeted contact precautions able to reduce the number of days patients spend in contact precautions and are they as effective at preventing hospital-acquired infection with MRSA and VRE? Study Design and Methods: A pragmatic, single-center, single-cluster, crossover pilot and feasibility trial in which all adults admitted to a single medical ICU alternated every 2 months between targeted and standard contact precautions for MRSA and VRE for a total of 8 months. In targeted periods, patients received contact precautions only for highly transmissible MRSA or VRE infections, including open wounds, uncontrolled diarrhea, or pneumonia. In standard periods, patients received contact precautions for any MRSA or VRE infection or colonization. The primary pilot outcome was hospital-acquired infection with MRSA or VRE. The primary feasibility outcome was the number of patients per day removed from contact precautions in the targeted group. Results: The trial enrolled 2,230 adults. During targeted months, 0.56 additional patients/d remained without contact precautions. Thirteen hospital-acquired infections with MRSA or VRE occurred during targeted months compared with 13 infections during standard months (P = .95). MRSA acquisition was higher in the targeted group (6.5% vs 3%; P = .03). Interpretation: Despite a slight reduction in patient-days spent with contact precautions during the targeted contact precautions periods, no statistically significant difference was found in hospital-acquired MRSA or VRE infections when comparing targeted with standard contact precautions in this pilot trial. Larger, multicenter trials should examine the benefits and risks of these interventions. Clinical Trial Registration: ClinicalTrials.gov; No.: NCT03268122; URL: www.clinicaltrials.gov