Hostname: page-component-848d4c4894-ndmmz Total loading time: 0 Render date: 2024-05-07T01:08:30.965Z Has data issue: false hasContentIssue false
  • English
  • Français

The Impact of Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus (VRE) Flags on Hospital Operations

Published online by Cambridge University Press:  29 March 2016

Erica S. Shenoy ,
Hang Lee ,
Taige Hou ,
Winston Ware ,
Erin E. Ryan ,
David C. Hooper  and
Rochelle P. Walensky
Erica S. Shenoy*
Affiliation:
Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
Hang Lee
Affiliation:
Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts
Taige Hou
Affiliation:
Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts
Winston Ware
Affiliation:
Clinical Care Management Unit, Massachusetts General Hospital, Boston, Massachusetts
Erin E. Ryan
Affiliation:
Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts
David C. Hooper
Affiliation:
Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
Rochelle P. Walensky
Affiliation:
Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
*
Address correspondence to Erica S. Shenoy, MD, PhD, 55 Fruit Street, Bulfinch 334, Infection Control Unit, Massachusetts General Hospital, Boston, MA 02114 (eshenoy@partners.org).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To determine the impact of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus (MRSA/VRE) designations, or flags, on selected hospital operational outcomes.

DESIGN

Retrospective cohort study of inpatients admitted to the Massachusetts General Hospital during 2010–2011.

METHODS

Operational outcomes were time to bed arrival, acuity-unrelated within-hospital transfers, and length of stay. Covariates considered included demographic and clinical characteristics: age, gender, severity of illness on admission, admit day of week, residence prior to admission, hospitalization within the prior 30 days, clinical service, and discharge destination.

RESULTS

Overall, 81,288 admissions were included. After adjusting for covariates, patients with a MRSA/VRE flag at the time of admission experienced a mean delay in time to bed arrival of 1.03 hours (9.63 hours [95% CI, 9.39–9.88] vs 8.60 hours [95% CI, 8.47–8.73]). These patients had 1.19 times the odds of experiencing an acuity-unrelated within-hospital transfer [95% CI, 1.13–1.26] and a mean length of stay 1.76 days longer (7.03 days [95% CI, 6.82–7.24] vs 5.27 days [95% CI, 5.15–5.38]) than patients with no MRSA/VRE flag.

CONCLUSIONS

MRSA/VRE designation was associated with delays in time to bed arrival, increased likelihood of acuity-unrelated within-hospital transfers and extended length of stay. Efforts to identify patients who have cleared MRSA/VRE colonization are critically important to mitigate inefficient use of resources and to improve inpatient flow.

Infect Control Hosp Epidemiol 2016;37:782–790

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 7 , July 2016 , pp. 782 - 790
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

a

Authors with equal contribution.

References

REFERENCES

1. David, MZ, Medvedev, S, Hohmann, SF, Ewigman, B, Daum, RS. Increasing burden of methicillin-resistant Staphylococcus aureus hospitalizations at US academic medical centers, 2003–2008. Infect Control Hosp Epidemiol 2012;33:782–789.Google Scholar
2. Jarvis, WR, Jarvis, AA, Chinn, RY. National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at United States health care facilities, 2010. Am J Infect Control 2012;40:194–200.Google Scholar
3. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L, Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007;35:S165–S193.Google Scholar
4. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L. Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35:10–S65–S164.CrossRefGoogle ScholarPubMed
5. Shenoy, ES, Walensky, RP, Lee, H, Orcutt, B, Hooper, DC. Resource burden associated with contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: The patient access managers’ perspective. Infect Control Hosp Epidemiol 2012;33:849–852.Google Scholar
6. McLemore, A, Bearman, G, Edmond, MB. Effect of contact precautions on wait time from emergency room disposition to inpatient admission. Infect Control Hosp Epidemiol 2011;32:298–299.CrossRefGoogle ScholarPubMed
7. Johnson, DW, Schmidt, UH, Bittner, EA, Christensen, B, Levi, R, Pino, RM. Delay of transfer from the intensive care unit: a prospective observational study of incidence, causes, and financial impact. Crit Care 2013;17:R128.Google Scholar
8. Bryce, EA, Tiffin, SM, Isaac-Renton, JL, Wright, CJ. Evidence of delays in transferring patients with methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus to long-term-care facilities. Infect Control Hosp Epidemiol 2000;21:270–271.Google Scholar
9. Reynolds, C, Kim, D, Kaplan, SH, et al. Are nursing homes less likely to admit methicillin-resistant Staphylococcus aureus carriers? Am J Infect Control 2014;42:63–65.CrossRefGoogle ScholarPubMed
10. National Center for Health Statistics. Health, United States, 2014: With Special Feature on Adults Aged 55–64. Hyattsville, MD: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2015.Google Scholar
11. Council of Teaching Hospitals and Health Systems. COTH Quarterly Survey of Hospital Operations & Financial Performance. Washington, DC: Association of American Medical Colleges; 2013.Google Scholar
12. Shenoy, ES, Kim, J, Rosenberg, ES, et al. Discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus: a randomized controlled trial comparing passive and active screening with culture and polymerase chain reaction. Clin Infect Dis 2013;57:176–184.Google Scholar
13. Searle, SR, Speed, FM, Milliken, GA. Population marginal means in the linear model: An alternative to least squares means. Am Statistician 1980;34:216–221.Google Scholar
14. Singer, AJ, Thode, HC Jr, Viccellio, P, Pines, JM. The association between length of emergency department boarding and mortality. Acad Emerg Med 2011;18:1324–1329.Google Scholar
15. Sri-On, J, Chang, Y, Curley, DP, et al. Boarding is associated with higher rates of medication delays and adverse events but fewer laboratory-related delays. Am J Emerg Med 2014;32:1033–1036.Google Scholar
16. Liu, SW, Chang, Y, Weissman, JS, et al. An empirical assessment of boarding and quality of care: delays in care among chest pain, pneumonia, and cellulitis patients. Acad Emerg Med 2011;18:1339–1348.CrossRefGoogle ScholarPubMed
17. Detsky, ME, Etchells, E. Single-patient rooms for safe patient-centered hospitals. JAMA 2008;300:954–956.CrossRefGoogle ScholarPubMed
18. Bobrow, M, Thomas, J. Inpatient care facilities. In: Kobus RL, Skaggs RL, Bobrow M, Thomas J, Payette TM, Kliment SA, eds. Building Type Basics for Healthcare Facilities. New York: John Wiley and Sons, 2000:131–192.Google Scholar
19. Shenoy, ES, Lee, H, Cotter, JA, et al. Impact of rapid screening for discontinuation of methicillin-resistant Staphylococcus aureus contact precautions. Am J Infect Control 2015.Google Scholar
20. Shenoy, ES, Paras, ML, Noubary, F, Walensky, RP, Hooper, DC. Natural history of colonization with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE): a systematic review. BMC Infect Dis 2014;14:177.CrossRefGoogle ScholarPubMed
21. Ellis, MW, Hospenthal, DR, Dooley, DP, Gray, PJ, Murray, CK. Natural history of community-acquired methicillin-resistant Staphylococcus aureus colonization and infection in soldiers. Clin Infect Dis 2004;39:971–979.Google Scholar
22. Scanvic, A, Denic, L, Gaillon, S, Giry, P, Andremont, A, Lucet, JC. Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage. Clin Infect Dis 2001;32:1393–1398.Google Scholar
23. Cretnik, TZ, Vovko, P, Retelj, M, et al. Prevalence and nosocomial spread of methicillin-resistant Staphylococcus aureus in a long-term-care facility in Slovenia. Infect Control Hosp Epidemiol 2005;26:184–190.Google Scholar
24. Byers, KE, Anglim, AM, Anneski, CJ, Farr, BM. Duration of colonization with vancomycin-resistant Enterococcus. Infect Control Hosp Epidemiol 2002;23:207–211.CrossRefGoogle ScholarPubMed
25. Park, I, Park, RW, Lim, SK, et al. Rectal culture screening for vancomycin-resistant Enterococcus in chronic haemodialysis patients: false-negative rates and duration of colonization. J Hosp Infect 2011;79:147–150.CrossRefGoogle Scholar
26. Yoon, YK, Lee, SE, Lee, J, et al. Risk factors for prolonged carriage of vancomycin-resistant Enterococcus faecium among patients in intensive care units: a case-control study. J Antimicrob Chemother 2011;66:1831–1838.CrossRefGoogle ScholarPubMed
27. Cluzet, VC, Gerber, JS, Nachamkin, I, et al. Duration of colonization and determinants of earlier clearance of colonization with methicillin-resistant Staphylococcus aureus . Clin Infect Dis 2015;60:1489–1496.Google Scholar
28. Haverkate, MR, Derde, LP, Brun-Buisson, C, Bonten, MJ, Bootsma, MC. Duration of colonization with antimicrobial-resistant bacteria after ICU discharge. Intensive Care Med 2014;40:564–571.Google Scholar
29. Rogers, C, Sharma, A, Rimland, D, et al. Duration of colonization with methicillin-resistant Staphylococcus aureus in an acute care facility: a study to assess epidemiologic features. Am J Infect Control 2014;42:249–253.Google Scholar
30. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L, Health Care Infection Control Practices Advisory Committee. 2007 guideline for isolation precautions: Preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35:S65–S164.CrossRefGoogle ScholarPubMed
31. van de Glind, I, de Roode, S, Goossensen, A. Do patients in hospitals benefit from single rooms? A literature review. Health Policy 2007;84:153–161.CrossRefGoogle ScholarPubMed
32. Chaudhury, H, Mahmood, A, Valente, M. Advantages and disadvantages of single- versus multiple-occupancy rooms in acute care environments: a review and analysis of the literature. Environment and Behavior 2005;37:760–786.Google Scholar
33. Furuno, JP, Perencevich, EN, Johnson, JA, et al. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci co-colonization. Emerging Infectious Diseases 2005;11:1539–1544.CrossRefGoogle ScholarPubMed
34. Morgan, DJ, Day, HR, Furuno, JP, et al. Improving efficiency in active surveillance for methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus at hospital admission. Infect Control Hosp Epidemiol 2010;31:1230–1235.Google Scholar