Thread by @rloganjonesmd

Because this tweet seemed to strike a nerve among so many;.

Suppose its #tweetorial time to evaluate the evidence supporting, or not, the use of contact precautions (CP) to prevent the transmission and infectious complications of #MRSA

https://twitter.com/rloganjonesmd/status/1092501970437300224

#MRSA first made its way to the greater medical knowledge in its debut publication in the @bmj_latest in 1961.

Since then, it has been chewing up penicillin (or at least altering its penicillin binding proteins) and making a name for itself.
You can now buy it in cute plush toy format :)
Also, it is really good at mimicking "spider bites"

All kidding aside, #MRSA infections really serious and a common cause of healthcare associated infection and even death. The CDC launched its first recommendations on what isolation techniques should be employed in the hospital setting

With the boom of Community Acquired MRSA in the 1990-2000s, more focus on how to stymie this took place. The @SHEA_Epi 2003 guidelines took a more firm stance recommending a more active approach to infection prevention and recommended contact precautions (Gowns + Gloves) for MRSA

But since that time, we've seen a blossoming of CP use in hospitals, but has this been the panacea to controlling MRSA that was sold?
In more recent years, the literature has been less than conclusive that contact precautions does much to combat MRSA

Dhar et al in 2014 published data showing that higher uses of CP may have the undue behavioral consequences resulting in poorer hand hygiene compliance and improper CP techniques

Morgan et al in 2015 performed a lit review and found mixed evidence that CP for MRSA yielded much benefit for infection control, and postulated there may be some inherent harm to patient care by the increasing use of CP

Kullar et al, 2016 coming out stating that using CP during epidemic rates of MRSA could be lower transmission rates but didn't show reduced infection rates. Also highlighting possible downsides to frequent isolation

& Marra et al in 2018's systematic review + metanalysis showed generally weak and likely flawed data, confounded often that gown & gloves were implemented with other interventions, and when removed did not seem to result in increased MRSA infection

Finally, 15 years later, the more recent SHEA guidelines do not actively endorse the use of gloves/gowns/contact precaution, taking more a line of letting local needs and prevalence of MRSA guide the utilization of contact precautions

Obviously, just scratch of the literature providing you reviews, but I hope this provides starting points of the data and continues to fuel convo with your local infection control staff whether gowns & gloves for #MRSA is helping or harming you patients

CC for feedback, comments, critiques: @gonzalobearman @OHSU_ID @UNMC_ID @RJmdphilly @medevidenceblog @VPrasadMDMPH @mike_edmond @ETSshow @amcvanrossum @lzavorszky @liseand