Discontinuation of Isolation

MRSA

Patients must be off MRSA-specific antibiotics for 72 hours and have no evidence of continued colonization with MRSA, as evidenced by negative nasal (anterior nares) cultures at day 0 and day 7. In addition, a culture from all draining wounds must be negative for MRSA x 1. Finally, cultures from the original site of isolation of MRSA, if obtainable without increased risk for substantial patient morbidity (e.g., tracheal aspirate culture in patient with tracheostomy is easily obtained; however, collection of pleural fluid for sole intent of removal off isolation precautions would not be required), should be negative x 1.

VRE

Patients must be off VRE-specific antibiotics for 72 hours and have no evidence of continued colonization with VRE, as evidenced by negative rectal or stool cultures at day 0, day 7 and day 14. In addition, cultures from the original site of isolation of VRE, if obtainable without increased risk for substantial patient morbidity (see above), should be negative x 1.

C. difficile infection 

All patients for whom a C. difficile test is ordered are placed on empiric Contact Precautions.

(-) If a test for C. difficile is ordered, and the patient is negative for C. difficile toxin gene by PCR (first part of the test) and an alternative diagnosis for the diarrheal symptoms is documented by the patient’s provider, then Contact Precautions may be discontinued.

(+, +: C. difficile INFECTION) If a patient is positive for C. difficile toxin gene by PCR, AND positive for C. difficile toxin by antigen detection, the patient can be removed from contact isolation per current VUMC guidelines as outlined below: 

  • The patient remains on contact isolation until the patient returns to his/her normal stooling pattern for minimum of 48 hours AND
  • Patient is off of C. difficile-specific treatment
  • Discharge or transfer from room so that all surfaces in room may be cleaned thoroughly
  • Patient must be bathed,
  • Place patient in a clean gown, and
  • Place patient in a clean bed if transferred to a new room

NOTE:  A negative test is NOT required (and should not performed) for removal from isolation. 

(+, -: C. difficile COLONIZATION) If a test for C. difficile is ordered, and the patient is positive for C. difficile toxin gene by PCR (first part of the test), BUT negative for C. difficile toxin by antigen detection (second part of the test), the following guidelines apply for removing contact isolation precautions:

  • The patient remains on contact isolation until the patient returns to his/her normal stooling pattern for minimum of 48 hours.
  • Discharge or transfer from room so that all surfaces in room may be cleaned thoroughly
  • Patient must be bathed,
  • Place patient in a clean gown, and
  • Place patient in a clean bed if transferred to a new room

NOTE: A negative test is NOT required (and should not performed) for removal from isolation

Multidrug-resistant (MDR) gram-negative organism (such as MDR Acinetobacter baumannii, CRE, and ESBL+ organisms)

Patients with non-carbapenemase producing CRE and ESBL+ orgainsm infection or colonization remain on Contact Precautions until the following are met:

  1. At least 6 months have elapsed since the last positive culture for the organism, AND
  2. The patient has negative rectal swab samples for the specific organism x 2 obtained at least 1 week apart.

Patients with carbapenemase-producing CRE or extensively-resistant gram-negative or other organism infection or colonization must stay on Contact Precautions until discharge from VUMC due to the high concern for nosocomial transmission of these agents and the limited number of antibiotics available to treat such pathogens.

Airborne precautions/TB

Removal from Airborne Precautions must be made in consultation with the Department of Infection Prevention. Specific information regarding the patients clinical symptoms, history, and lab data will be used to determine appropriateness for removal. Please click here for details on the Department of Infection Prevention's process for removal from Airborne Precautions.