Taking of the gloves: a less dogmatic approach to the use of contact precautions

Taking off the gloves: toward a less dogmatic approach to the use of contact isolation
by Kathryn Kirkland

This review looks at the benefits and harms of isolation as a public health measure and proposed a framework for considering under what circumstances contact precautions might be used.

According to SHEA's recommendation - individuals whpo are thought to pose an infectious threat to others are placed in private rooms, or cohorted with patient(s) with the same infection.
They are cared by healthcare workers wearing PPE. PPE includes masks, gown, and gloves.

Benefits are not for the individual patient but for the greater good of the other patients. But for the individual patient the contact isolation can be intimidating. It is restrictive to the patient. Isolation has the costs of all the supplies that are needed for gowns, gloves and face masks.

The author feels there are 3 ways patients acquire infections:
1. Directly through contact with other patients (more uncommon even in a shared room)
2. Indirectly through contaminated hands of a healthcare worker.
3. Indirectly through environmental items.

The author of this article does not like contact isolation and the ramifications of it.
Her articulation in this article does bring new thoughts to light.
Contact isolation does try to prevent the transmission of microorganisms from patient to patient (which is thought through the hands of healthcare workers or environemntal items (such a sygmomanometers, thermometers, and pulse oximitry).
But a patient's own flora can be oportunistic and cause and infection, isolation would not help them.
The author feels that even if patients are exposed to bacter, the bacteria "hang out" until the patient's defenses aredown, and infection occurs.

This author feels that contact isolation should be done on a case by case basis not by generalize screen of cultures specific for certain MDROs.
I do not agree with this. There are flaws in the screening process, there has to be a base for which a hospital needs to start to do surveillance on their patients.
Today in 2010, the potential for exposure to an MDRO bacteria that is resitant to all known antibiotics is greater than in 2009. ANd in my hospital the LTAC, the patients who have been exposed to the hospital system, antibotics, and invaisive procedures. In this specific population,the risk of exposure is so great that I do not have a problem with contact precautions.

In an ideal world, private rooms for every patient would get away from "isolation" mindset.
Some hospitals are new, but a lot are old. The older hospitals have been reovated. The renovation process until recent times did not include private rooms. Private rooms require more space.

The author even with the research has not thought through all the scenarios possible. She had not through through the scenario of CRE (carbapebem resitant enterobacteria). Which there are no current antibiotics to treat.

So although I respect the authors research anf view and cannot concur with her.