Ms Susan Jain, Infection Control Clinician Nurse Consultant
PRINCE OF WALE PUBLIC HOSPITAL
This discussion paper explores a historical perspective on practices related to prevention of infection (with a particular focus on Contact Precautions (CP) for Methicillin Resistant Staphylococcus Aureus: MRSA) in order to understand the present and guide future practice.
Since the 1900s all healthcare settings have been affected by the emergence and transmission of antibiotic resistant bacteria. These Multidrug Resistant Organisms (MROs), including Methicillin Resistant Staphylococcus Aureus (MRSA) and Vancomycin Resistant Enterococcus (VRE), have important infection control and financial implications for hospitals.
This paper seeks to assist understanding of the evolution of isolation and contact precautions in the management of communicable diseases during the past seven and a half centuries. It explores the value of infection prevention and control strategies that are currently recommended in healthcare settings. Antimicrobials are an important part of infection prevention and control and the introduction and evolution of antibiotics usage play an important role in understanding the strategies currently in use. In order to contextualise the evolution this review explores the outbreaks of bubonic plague, Leprosy control, the practice of wound management, the identification of Staphylococcus Aureus, the discovery of antibiotics and the emergence of antibiotic resistant bacteria. A particular focus is on the advent of source isolation and contact precautions for MROs (predominantly MRSA).
This review outlines the need for further investigation to guide evidence based practice in infection prevention and control to reduce the transmission of micro-organisms between patients in the healthcare setting. An important direction for future work is to focus on study designs to evaluate the long term sustainability and cost effectiveness of contact precautions to improve person-centred care.