New guidance offers hospitals the first standardized recommendations on ending safety protocols when treating patients for multidrug-resistant infections.
The guidance suggests clinicians determine how long they should use gowns, gloves and masks when treating patients with antimicrobial-resistant pathogens, as well as deciding how long those patients should remain in isolation.
Co-author Dr. Gonzolo Bearman, chair of the division of Infectious Diseases at Virginia Commonwealth University Health System, said most clinical research has focused on proper protocols at the beginning and throughout the treatment of a patient. But there's been little information on the safest way to end such precautions. That's led to varying procedures and potentially, spread of infection and overuse of antibiotics.
The recommendations from the Society for Healthcare Epidemiology of America were published Thursday in the journal Infection Control and Hospital Epidemiology.
"Because of the virulent nature of multi-drug 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 paper co-author Dr. David Banach, hospital epidemiologist at University of Connecticut Health Center.
The Center for Disease Control and Prevention estimates more than 2 million people in the U.S. get drug-resistant infections every year, the majority of which are acquired at healthcare facilities. About 23,000 infected people die annually. The cost to treat those patients is about $20 billion a year.
Recommendations focused on some of the most common and difficult drug-resistant infections to treat, such as MRSA, Carbapenem-resistant Enterobacteriaceae (CRE), and Clostridium difficile, regarded as the most common microbial cause of healthcare-associated infections with an estimated 453,000 cases every year, according to the CDC.
In most cases, the recent guidance suggests hospital personnel decide to end safety precautions based on how much time has elapsed since the last positive culture. That would determine if contact transmission is likely.
"The duration of contact precautions can have a significant impact on the health of the patient, the hospital, and the community," Bearman said. "This guidance is a starting point, however stronger research is needed to evaluate and optimize the use."
Slowing down the spread of antimicrobial-resistant pathogens has become a priority among health officials, clinicians and policy makers in recent years as the number of antibiotics that can be used to effectively treat such infections continues to dwindle. A large contributor to the problem of antimicrobial resistance has been the overuse of antibiotics, both in healthcare and in livestock.
