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Contact Precautions for Endemic MRSA and VRE: Time to Retire Legal Mandates.

Physical barriers have been used to prevent infectious diseases dating back to leather gloves and coats used during the Black Death in medieval Europe. In the United States, isolation of persons with infections coincided with the development of infectious disease hospitals during the 19th century and introduction of “barrier nursing” in 1910, which included the use of gowns for health care workers. The US Centers for Disease Control and Prevention (CDC) released isolation manuals starting in 1970, promoting the idea of specific precautions within 7 categories (such as strict isolation, respiratory isolation, or wound and skin precautions), easily adopted by any type of hospital. The CDC guidance was based on expert opinion and theoretical modes of transmission. In the 1980s, the human immunodeficiency virus (HIV) epidemic led to universal precautions, in which all blood and certain body fluids were considered to be and approached as if infectious for HIV, hepatitis B virus, and other blood-borne pathogens. Concurrently, body substance isolation was developed, consisting of gloves and gowns for contact with secretions and moist body surfaces.1 Two guidelines were combined to form standard precautions, specifying the use of gloves, gowns,