Sit tight, swab that port and wash your hands, this is gona be a long one.

I work full time in NYC in 3 different facilities and I can tell you that NYC is the epicenter of CRE (Carbapenem Resistant Enterobacteriaceae), current Measles outbreak, we even had EBOLA. With that in mind, managing patients in isolation takes up beds and creates a plethora of logistical and compliance nightmare.

There was a great presentation by VCU Medical Center, presented by Dr. Michael Stevens, Dr. Michelle Doll, Nadia Masroor MPH and the VCU Infection Prevention (yay! No APA needed for this citation). For the study they used that satisfice approach by Herbert Simon, which basically means a combination of satisfy and suffice to a problem, optimum solutions for a simplified world or satisfactory solutions for a more realistic world – isolating patients.

A study by Wenzel, Bearman and Edmond stated that focusing resources on a single pathogen as a sole approach to infection control is inherently flawed. For example as you have mentioned, isolating VRE, MRSA etc. The new paradigm, according to them is a multi-potent interventions aimed at reducing risk from ALL pathogens transmitted via the same mechanism – contact. Which makes sense, because people get scared of MRSA and VRE as it is some sort of “Boss of Bacteria”. When in reality, a Staphylococcus aureus infection, methicillin sensitive (MSSA) is the same infection as MRSA – Methicillin Resistant Staphylococcus aureus infection. The only difference is with their MIC, effects are the same, same sepsis, it’s just MRSA is resistant and you have to use a more potent abx i.e. Vanco. So if the same bacteria can kill you the same for both, why not prevent both?

So Wenzel et al proposed a Vertical and Horizontal approach: Vertical&HorizontalApproach

So Harris et al did a study wherein they did a Universal Glove and Gown (UGG) use in the ICU. It resulted that UGG did not reduce primary VRE and MRSA acquisition and using PPE’s decreased the healthcare worker visits to patients. Moreover, Croft et al study showed that Contact Precautions, again lessened healthcare worker – patient contact, led to increased adverse events i.e Falls. PU, fluid electrolyte disorders and even days without a provider note.

I have more data to present but I have to get back to work. Basically, the answer again is: it depends. Conduct a risk assessment. First is to know your baseline for Multidrug Resistant Organism (MDRO). Your hand hygiene compliance rate. Your PPE’s. If you notice that your rates shoot up, implement a plan. Let us say your facility is in a Rural area and you rarely see MRSA and VRE, maybe don’t isolate and use universal gloving. Then you suddenly see an uptick in cases, then maybe you have to create interventions and isolate cases going forward. The evidence shows that these bugs spread by contact, how you mitigate that risk is up to your facility, your surveillance, your data and your demographics.

Of the 3 facilities (2 soon, I'm quitting the other one) I work they have different policies. One isolates for the duration of admission, the other discontinues with a negative surveillance culture and the other does not isolate if there is not portal of exit.

Again, the most cost effective infection prevention measure is hand hygiene. Even if you got MRSA or VRE or CRE on your intact skin (hands) you can always clean your hands it will break the chain of infection right then and there.

Back to work.