The patient is off all antibiotics for a minimum of 48 hours assuming normal renal function (If the patient has impaired renal function or is in dialysis, then the appropriate interval of time for clearance of all antibiotics should have elapsed before culturing the patient).
Two sequential cultures of the anterior nares obtained a minimum of 24 hours apart are negative. The cultures must be labeled "R/O MRSA".
Two sequential cultures from the site of infection/colonization (if applicable) obtained 24 hours apart are negative. The cultures must be labeled "R/O MRSA" if obtained from a body site that is usually not sterile (e.g. wound, decubitus, etc.).
Note: MRSA colonization is usually prolonged (weeks to years); therefore, it is usually not fruitful to try to remove a patient with MRSA from Contact Precautions.
Two sequential perirectal swabs obtained a minimum of 24 hours apart are negative.
Two sequential cultures from the site of infection/colonization (if applicable) obtained 24 hours apart are negative. The cultures must be labeled "R/O VRE" if obtained from a body site that is usually not sterile (e.g. wound, decubitus, etc.).
Preferably, the patient should be off all antibiotics for a minimum of 48 hours assuming normal renal function (If the patient has impaired renal function or is on dialysis, then the appropriate interval of time for clearance of all antibiotics should have elapsed before culturing of the patient).
Note: VRE colonization is usually prolonged (weeks to years), especially in ESRD, HIV, transplant, and oncology patients. Additionally, patients can flip/flop during an inpatient admission; therefore, attempting to remove a patient from Contact Precautions for VRE is usually not a successful endeavor.
C.difficile colitis (diarrhea):
Contact Precautions can be discontinued once the diarrhea has resolved. There is no need to send a follow-up toxin titer once the diarrhea has resolved.
RSV (Respiratory Syncytial Virus):
Contact Precautions can be discontinued once the symptoms (fever, cough, wheezing, etc.) have resolved.
Parainfluenza Virus:
Contact Precautions can be discontinued once the symptoms (fever, cough, etc.) have resolved.
Epidemiologically Significant Organisms (such as very resistant Acinetobacter baumanii, Stenotrophomonas maltophilia, Pseudomonas aeruginosa, etc.):
To remove such patients from Contact Precautions, consultation with Hospital Epidemiology (8-4634) is mandatory.
Refer to the Disease List for other organisms/diseases requiring Contact Precautions and the duration of such precautions.
