1. Contact precautions.

Contact precautions (CP) consist in applying the following measures:

  • use dedicated equipment (blood pressure cuff, thermometer, and stethoscope);

  • put on gown and gloves before entry to the patient’s room;

  • change gloves immediately if visibly soiled, and after touching or handling surfaces or materials contaminated with faeces;

  • remove gown and gloves before exiting the room;

  • if cohorting is used, change the gown and gloves and perform hand hygiene after caring for one patient and prior to providing care for the next patient;

  • routinely check available supplies for contact precautions to ensure that adequate selection and amounts are readily available.

There is no study focused on the use of surgical masks as a component of CP in the management of patients with respiratory colonization or infection due to MDR-Gram-negative bacteria. A few papers reporting outbreaks due to MDR-A. baumannii added masks on the top of CP in the ICU settings with favourable results. However, the low quality of evidence and the heterogeneity of case-mix of patients do not support generalizing this intervention [1].

In the SHEA guideline for preventing nosocomial transmission of MDR S. aureus and Enterococcus it was recommended to wear masks as part of isolation precautions when entering the room of a patient colonized or infected with MRSA to decrease nasal acquisition by HCWs. However this issue has not been studied adequately [2].

References.

  1. Tacconelli E, Cataldo MA, Dancer SJ, De Angelis G, Falcone M, Frank U, et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect. 2014 Jan;20 Suppl 1:1-55.
  2. Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol. 2003 May;24(5):362-86.

Original contribution from:

Maria Adriana Cataldo and Nicola Petrosillo, National Institute for Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy.