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Duration of Contact Precautions

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Guidance ➤ Outside an outbreak setting and if facility endemic rates of VRE infection are low, the hospital may consider the alternative approach of using CP for patients with active VRE infection for the duration of the index admission and discontinuing CP on hospital discharge. • In adopting this approach, hospitals should monitor VRE infection rates, maximize and consider monitoring use of standard precautions, and minimize patient cohorting to avoid intrafacility transmission. • If institutional VRE infection rates increase, the hospital should transition to a screening culture–based approach for discontinuation of CP. Multidrug-Resistant Enterobacteriaceae (MDR-E) ➤ If a hospital uses CP for patients infected or colonized with MDR-E (ESBL-E and/or CRE), SHEA recommends establishing a policy for discontinuation of CP for MDR-E that includes the following: • Maintaining CP for ESBL-E and CRE for the duration of the index hospital stay when infection or colonization with these bacteria is first detected. • Considering discontinuation of CP on a case-by-case basis, taking into account the following criteria: ▶ at least 6 months have elapsed since the last positive culture ▶ presence of a clinical infection and ongoing antibiotic use, where discontinuation of CP should be discouraged in the setting of suspected or known infection with ESBL-E or CRE, and concurrent broad spectrum antibiotic use that may select for these organisms, and ▶ procurement of an adequate number of screening samples, with at least 2 consecutive negative rectal swab samples obtained at least 1 week apart to consider an individual negative for ESBL-E or CRE colonization. ➤ SHEA recommends that for extensively drug-resistant Enterobacteriaceae, such as carbapenemase-producing CRE, or Enterobacteriaceae with very limited treatment options (susceptible to ≤2 antibiotic classes used to treat that organism), hospitals should maintain CP indefinitely.

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