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Impact of Discontinuing Contact Precautions for Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus: An Interrupted Time Series Analysis

  • Gonzalo Bearman (a1) (a2), Salma Abbas (a1), Nadia Masroor (a2), Kakotan Sanogo (a2), Ginger Vanhoozer (a2), Kaila Cooper (a2), Michelle Doll (a1) (a2), Michael P. Stevens (a1) (a2) and Michael B. Edmond (a3)...

Abstract

OBJECTIVE

To investigate the impact of discontinuing contact precautions among patients infected or colonized with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) on rates of healthcare-associated infection (HAI). DESIGN. Single-center, quasi-experimental study conducted between 2011 and 2016.

METHODS

We employed an interrupted time series design to evaluate the impact of 7 horizontal infection prevention interventions across intensive care units (ICUs) and hospital wards at an 865-bed urban, academic medical center. These interventions included (1) implementation of a urinary catheter bundle in January 2011, (2) chlorhexidine gluconate (CHG) perineal care outside ICUs in June 2011, (3) hospital-wide CHG bathing outside of ICUs in March 2012, (4) discontinuation of contact precautions in April 2013 for MRSA and VRE, (5) assessments and feedback with bare below the elbows (BBE) and contact precautions in August 2014, (6) implementation of an ultraviolet-C disinfection robot in March 2015, and (7) 72-hour automatic urinary catheter discontinuation orders in March 2016. Segmented regression modeling was performed to assess the changes in the infection rates attributable to the interventions.

RESULTS

The rate of HAI declined throughout the study period. Infection rates for MRSA and VRE decreased by 1.31 (P=.76) and 6.25 (P=.21) per 100,000 patient days, respectively, and the infection rate decreased by 2.44 per 10,000 patient days (P=.23) for device-associated HAI following discontinuation of contact precautions.

CONCLUSION

The discontinuation of contact precautions for patients infected or colonized with MRSA or VRE, when combined with horizontal infection prevention measures was not associated with an increased incidence of MRSA and VRE device-associated infections. This approach may represent a safe and cost-effective strategy for managing these patients.

Infect Control Hosp Epidemiol 2018;39:676–682

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Copyright

Corresponding author

Address correspondence to Nadia Masroor, MPH, VCU Health, 1300 East Marshall Street, Box 980019, Richmond, VA 23298 (Nadia.masroor@vcuhealth.org).

References

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Impact of Discontinuing Contact Precautions for Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus: An Interrupted Time Series Analysis

  • Gonzalo Bearman (a1) (a2), Salma Abbas (a1), Nadia Masroor (a2), Kakotan Sanogo (a2), Ginger Vanhoozer (a2), Kaila Cooper (a2), Michelle Doll (a1) (a2), Michael P. Stevens (a1) (a2) and Michael B. Edmond (a3)...

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