A discrete choice experiment to evaluate healthcare personnel preferences regarding risk-tailored policies for contact precautions for patients with methicillin-resistant Staphylococcus aureus

Background: An alternative to an "all or none" approach to contact precautions for patients with MRSA carriage may be a "risk-tailored" approach - using gloves and gowns only for certain high-risk activities, locations, or roles. Methods: We distributed a discrete choice experiment to healthcare personnel (HCPs) in three cities. Respondents were presented with eight choice sets, each consisting of two hypothetical policy options for glove and gown use to prevent MRSA transmission. In each comparison, respondents selected their preferred option. Using mixed logit modeling we calculated utility derived from each policy component, probability of uptake for the most favored policies, and heterogeneity in preferences based on HCP role. Results: In total, 326 HCPs completed the survey. 237 (54%) respondents reported wearing gloves and gowns 'all the time' when required. Respondents' preferred policy with the highest utility score was to use gloves and gown for all HCPs roles (utility, 0.17; 95% CI, 0.12 to 0.23), in high-risk settings (utility, 0.12; 95% CI 0.07-0.18), when touching the patient (utility, 0.11; 95% CI 0.06-0.17). Sixty-three percent (95% CI 60-66) would support a risk-tailored approach over an approach where contact precautions are used by all HCPs in all settings and for all activities. Support varied by HCP role (p < 0.02), with the strongest probability of support from physicians and advanced practice providers (77%, 95% CI 72%-82%) and the least support from environmental services personnel (45%, 95% CI 37%-53%). Conclusions: This discrete choice survey demonstrates that most HCPs prefer a risk-tailored approach to contact precautions when caring for patients with MRSA.