Contact precautions for multi-resistant pathogens – is it time to go horizontal?

Joanna Harris 1

Manager, Infection Management And Control Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia

 

Introduction
Contact Precautions (CP), first prescribed in managing patients with multi-resistant organisms (MROs) in the 1970s, continue to be used in today’s healthcare across the developed world.
This presentation summarises the literature, to explore the application of CP in contemporary healthcare, from an ethics perspective.

Method
A review of the literature surrounding healthcare ethics and the use of CP in acute hospital settings.

Results
Despite consistent terminology there is a wide variation in the implementation of CP within policy documents, and in clinical practice. This may explain the conflicting evidence surrounding the efficacy of CP, and their impact on patients, although poor study design may also contribute. It is identified that healthcare workers (HCW) find CP difficult to maintain and their decision-making may be founded upon outdated or incomplete microbiological information. It is known that the mortality-rate from significant MRO infections may not differ from the rate when an antibiotic-sensitive strain is responsible.
The effect of CP on patient and HCW autonomy, the potential for CP to precipitate adverse events, healthcare inequities and stigmatisation, are recognised as they were in 1985 when, in response to concerns about human immunodeficiency virus (HIV), horizontal strategies for blood contact, known as Universal Precautions, were developed.

Conclusion
Conflicting evidence for the efficacy of CP, along with ethical concerns, mean it is time to reconsider CP for MRO management. Horizontal infection prevention and control strategies would fulfil the aims of primary health promotion by reducing transmission of MROs whilst safeguarding key principles of healthcare ethics.

About the College

The ACIPC is the peak body for Infection Prevention and Control professionals in the Australasian region. Our stated vision is the prevention and control of infection in our communities. We commenced in January 2012 bringing together the various State and Territory infection control associations formerly in AICA (The Australian Infection Control Association) to support and encourage collaboration across Australasia.

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