Guidance
Methicillin-Resistant Staphylococcus aureus (MRSA)
➤ If a hospital uses CP for patients previously colonized or infected with
MRSA, SHEA recommends establishing a policy for the discontinuation of
CP for MRSA.
➤ For patients not on antimicrobial therapy with activity against MRSA,
SHEA recommends negative screening cultures to guide decisions about
discontinuation of CP.
• The optimal number of negative cultures needed is unclear, though 1–3 negative cultures
are often used.
• The anterior nares are a common site of culture sampling, though the literature is unclear
regarding the optimal site and the role of extra-nasal sampling.
➤ For high-risk patients, such as those with chronic wounds or patients from
long-term care facilities, SHEA recommends extending CP from the last
MRSA-positive culture, prior to assessing for CP discontinuation.
➤ Outside an outbreak setting, if a facility's endemic rates of MRSA infection
are low, the hospital may consider the alternative approach of using CP for
patients with active MRSA infection for the duration of the index admission
and discontinuing CP on hospital discharge.
• In adopting this approach, a hospital should monitor facility MRSA infection rates,
maximize and consider monitoring use of standard precautions, and minimize patient
cohorting to avoid intrafacility transmission.
• If the hospital's MRSA infection rates increase, the hospital should transition to a
screening culture–based approach for discontinuation of CP.
Vancomycin-Resistant Enterococci (VRE)
➤ If a hospital uses CP when caring for patients colonized or infected with VRE,
SHEA recommends establishing a policy for discontinuation of CP for VRE.
➤ SHEA recommends that, following treatment of VRE infection, the hospital
use negative stool or rectal swab cultures to guide decisions about the
discontinuation of CP.
• The optimal number of negative cultures needed is unclear, though 1–3 negative
cultures, each at least 1 week apart if multiple cultures are obtained, are often used.
➤ Hospitals should consider extending CP prior to assessing for CP
discontinuation in VRE infected patients who are:
• highly immunosuppressed
• receiving broad spectrum systemic antimicrobial therapy without VRE activity
• receiving care in protected environments (e.g., burn units, bone marrow transplant units
or settings with neutropenic patients), or
• receiving care at institutions with high rates of VRE infection.
