Control of drug-resistant pathogens in endemic settings: contact precautions, controversies, and a proposal for a less restrictive alternative.

Contact precautions are routinely employed for the control of multidrug-resistant organisms. Robust measures, however, for the incremental benefit of contact precautions, gowns, gloves, and active detection and isolation strategies for the prevention of cross-transmission in endemic settings are lacking. Unintended consequences and adverse effects from contact precautions, including patient dissatisfaction with care, depression, medication errors, and fewer provider visits, have been reported. Universal gloving strategies in lieu of contact precautions have produced mixed results and raise concerns about a decrease in hand hygiene by glove wearers. We suggest that the use of a sound, horizontal infection prevention strategy that widely and consistently implements infection prevention best practices may be a sufficient and least restrictive alternative strategy for the control of endemic multidrug-resistant pathogens.