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Impact of Contact and Droplet Precautions on the Incidence of Hospital-Acquired Methicillin-Resistant Staphylococcus aureus Infection

Published online by Cambridge University Press:  02 January 2015

Ed Mangini ,
Sorana Segal-Maurer ,
Janice Burns ,
Annette Avicolli ,
Carl Urban ,
Noriel Mariano ,
Louise Grenner ,
Carl Rosenberg  and
James J. Rahal
Ed Mangini*
Affiliation:
Infectious Diseases Section of the Department of Medicine, New York
Sorana Segal-Maurer
Affiliation:
Departments of Medicine, Weill Cornell Medical College, New York
Janice Burns
Affiliation:
Department of Nursing, New York Hospital Medical Center of Queens, Flushing, New York
Annette Avicolli
Affiliation:
Departments of Medicine, Weill Cornell Medical College, New York
Carl Urban
Affiliation:
Microbiology, Weill Cornell Medical College, New York
Noriel Mariano
Affiliation:
Infectious Diseases Section of the Department of Medicine, New York
Louise Grenner
Affiliation:
Infectious Diseases Section of the Department of Medicine, New York
Carl Rosenberg
Affiliation:
Taro Pharmaceuticals, Hawthorne, New York
James J. Rahal
Affiliation:
Departments of Medicine, Weill Cornell Medical College, New York
*
Infectious Diseases Section, Department of Medicine, New York Hospital Medical Center of Queens, 56-45 Main Street, Flushing, NY 11355 (edm9010@nyp.org)
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Abstract

Objective.

To evaluate the efficacy of contact and droplet precautions in reducing the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections.

Design.

Before-after study.

Setting.

A 439-bed, university-affiliated community hospital.

Methods.

To identify inpatients infected or colonized with MRSA, we conducted surveillance of S. aureus isolates recovered from clinical culture and processed by the hospital's clinical microbiology laboratory. We then reviewed patient records for all individuals from whom MRSA was recovered. The rates of hospital-acquired MRSA infection were tabulated for each area where patients received nursing care. After a baseline period, contact and droplet precautions were implemented in all intensive care units (ICUs). Reductions in the incidence of hospital-acquired MRSA infection in ICUs led to the implementation of contact precautions in non-ICU patient care areas (hereafter, “non-ICU areas”), as well. Droplet precautions were discontinued. An analysis comparing the rates of hospital-acquired MRSA infection during different intervention periods was performed.

Results.

The combined baseline rate of hospital-acquired MRSA infection was 10.0 infections per 1,000 patient-days in the medical ICU (MICU) and surgical ICU (SICU) and 0.7 infections per 1,000 patient-days in other ICUs. Following the implementation of contact and droplet precautions, combined rates of hospital-acquired MRSA infection in the MICU and SICU decreased to 4.3 infections per 1,000 patient-days (95% confidence interval [CI], 0.17-0.97; P = .03). There was no significant change in hospital-acquired MRSA infection rates in other ICUs. After the discontinuation of droplet precautions, the combined rate in the MICU and SICU decreased further to 2.5 infections per 1,000 patient-days. This finding was not significant (P = .43). In the non-ICU areas that had a high incidence of hospital-acquired MRSA infection, the rate prior to implementation of contact precautions was 1.3 infections per 1,000 patient-days. After the implementation of contact precautions, the rate in these areas decreased to 0.9 infections per 1,000 patient-days (95% CI, 0.47-0.94; P = .02).

Conclusion.

The implementation of contact precautions significantly decreased the rate of hospital-acquired MRSA infection, and discontinuation of droplet precautions in the ICUs led to a further reduction. Additional studies evaluating specific infection control strategies are needed.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 11 , November 2007 , pp. 1261 - 1266
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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