Less contact isolation is more in the ICU: not sure

  • J. C. Lucet
  • A. D. Harris
  • B. GuidetEmail author
Less is more in Intensive Care

The debate over the use of standard precautions (SPs) versus contact precautions (CPs) for stopping the spread of multidrug-resistant organisms (MDROs) has been controversial for years [1, 2, 3, 4, 5] and still persists, despite recent high-quality cluster-randomized studies [6, 7, 8, 9]. SPs are based on a universal (also called “horizontal”) approach to all patients, whether or not they are known to be as MDRO carriers; SPs include compliance with hand hygiene and cleaning the environment. CPs with a so-called “vertical” approach still include compliance with SPs for all patients, additional control barriers for colonized patients, i.e. gloves and gown, and placement in a single room if possible. Identification of MDRO carriage through screening is frequently associated with CPs.

The introduction of alcoholic handrub (AHR) in the early 2000s has been a major step in improving compliance with hand hygiene in healthcare settings. Many studies have demonstrated that including AHR in a...



AH received funding from National Institute of Allergy and Infectious Diseases: R01 AI121146-01.

Compliance with ethical standards

Conflicts of interest

JCL and BG have no COI.


  1. 1.
    Kirkland KB (2009) Taking off the gloves: toward a less dogmatic approach to the use of contact isolation. Clin Infect Dis 48(6):766–771CrossRefGoogle Scholar
  2. 2.
    Morgan DJ, Wenzel RP, Bearman G (2017) Contact precautions for endemic MRSA and VRE: time to retire legal mandates. JAMA 318(4):329–330CrossRefGoogle Scholar
  3. 3.
    Rubin MA, Samore MH, Harris AD (2018) The importance of contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. JAMA 319(9):863–864CrossRefGoogle Scholar
  4. 4.
    Tschudin-Sutter S, Lucet JC, Mutters NT, Tacconelli E, Zahar JR, Harbarth S (2017) Contact precautions for preventing nosocomial transmission of extended-spectrum beta lactamase-producing Escherichia coli: a point/counterpoint review. Clin Infect Dis 65(2):342–347CrossRefGoogle Scholar
  5. 5.
    Marra AR, Edmond MB, Schweizer ML, Ryan GW, Diekema DJ (2018) Discontinuing contact precautions for multidrug-resistant organisms: a systematic literature review and meta-analysis. Am J Infect Control 46(3):333–340CrossRefGoogle Scholar
  6. 6.
    Jain R, Kralovic SM, Evans ME, Ambrose M, Simbartl LA, Obrosky DS et al (2011) Veterans affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 364(15):1419–1430CrossRefGoogle Scholar
  7. 7.
    Huskins WC, Huckabee CM, O’Grady NP, Murray P, Kopetskie H, Zimmer L et al (2011) Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 364(15):1407–1418CrossRefGoogle Scholar
  8. 8.
    Derde LP, Dautzenberg MJ, Bonten MJ (2012) Chlorhexidine body washing to control antimicrobial-resistant bacteria in intensive care units: a systematic review. Intensive Care Med 38(6):931–939CrossRefGoogle Scholar
  9. 9.
    Harris AD, Pineles L, Belton B, Johnson JK, Shardell M, Loeb M et al (2013) Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA 310(15):1571–1580PubMedPubMedCentralGoogle Scholar
  10. 10.
    Dhar S, Marchaim D, Tansek R, Chopra T, Yousuf A, Bhargava A et al (2014) Contact precautions: more is not necessarily better. Infect Control Hosp Epidemiol 35(3):213–221CrossRefGoogle Scholar
  11. 11.
    Gurieva T, Dautzenberg MJD, Gniadkowski M, Derde LPG, Bonten MJM, Bootsma MCJ (2018) The transmissibility of antibiotic-resistant enterobacteriaceae in intensive care units. Clin Infect Dis 66(4):489–493CrossRefGoogle Scholar
  12. 12.
    Schwaber MJ, Carmeli Y (2014) An ongoing national intervention to contain the spread of carbapenem-resistant enterobacteriaceae. Clin Infect Dis 58(5):697–703CrossRefGoogle Scholar
  13. 13.
    Stone SP, Fuller C, Savage J, Cookson B, Hayward A, Cooper B et al (2012) Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study. BMJ 344:e3005CrossRefGoogle Scholar
  14. 14.
    Slayton RB, Toth D, Lee BY, Tanner W, Bartsch SM, Khader K et al (2015) Vital signs: estimated effects of a coordinated approach for action to reduce antibiotic-resistant infections in health care facilities—United States. MMWR Morb Mortal Wkly Rep 64(30):826–831CrossRefGoogle Scholar
  15. 15.
    Srigley JA, Furness CD, Baker GR, Gardam M (2014) Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: a retrospective cohort study. BMJ Qual Saf 23(12):974–980CrossRefGoogle Scholar
  16. 16.
    Kizny Gordon AE, Mathers AJ, Cheong EYL, Gottlieb T, Kotay S, Walker AS et al (2017) The hospital water environment as a reservoir for carbapenem-resistant organisms causing hospital-acquired infections-a systematic review of the literature. Clin Infect Dis 64(10):1435–1444CrossRefGoogle Scholar
  17. 17.
    Septimus E, Weinstein RA, Perl TM, Goldmann DA, Yokoe DS (2014) Approaches for preventing healthcare-associated infections: go long or go wide? Infect Control Hosp Epidemiol 35(Suppl 2):S10–S14CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Université de Paris, IAME, INSERM, AP-HP, Hôpital Bichat, Infection Control UnitParisFrance
  2. 2.School of MedicineUniversity of MarylandBaltimoreUSA
  3. 3.Medical ICUSorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, service de réanimationParisFrance

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