Contact Precautions for Endemic MRSA and VRE

Morgan, Daniel J.; Wenzel, Richard P.; Bearman, Gonzalo

doi:10.1001/jama.2017.7419

Cited by 64 publications

(47 citation statements)

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“…5 Moreover, this strategy may lead to depression, anxiety, and dissatisfaction among patients 5 through delays in diagnostic procedures, 6 charting of vital signs, transport and even hospital discharge. 1 The controversy was further heightened when Croft et al 6 recently reported no differences in preventable adverse events in isolated patients during a matched cohort trial. The most recent CDC guidelines for isolation precautions date back to 2007 and recommend the use of PPE, including gloves and isolation gowns, upon contact with all patients infected or colonized with multidrug-resistant organisms (MDROs), including MRSA and VRE.…”

Section: Discussionmentioning

confidence: 99%

“…With advances in the field of infectious prevention, the use of personal protective equipment (PPE) evolved from leather gloves and coats during medieval ages to disposable gloves and isolation gowns in the 21st century. 1 The use of isolation precautions (ie, gloves and gowns) for patients infected with or colonized by methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) is recommended by the Centers for Disease Control and Prevention (CDC) in the most recent guidelines to prevent healthcare-associated infections (HAIs) caused by these organisms. 2 While contact precautions have been considered an important strategy to prevent HAIs caused by MRSA and VRE, a growing body of evidence suggests that this may be unnecessary.…”

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confidence: 99%

“…1,3,4 Currently, more than 40 hospitals in the United States limit their use of contact precautions to situations such as patients with draining wounds, infectious diarrhea, and the care of high-risk patients. 1 While no reports exist of harm related to the discontinuation of contact precautions, this strategy remains controversial. We employed an interrupted time series (ITS) analysis to assess the impact of discontinuing contact precautions for MRSA-or VRE-infected or -colonized patients in an academic medical center.…”

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confidence: 99%

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Impact of Discontinuing Contact Precautions for Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcus: An Interrupted Time Series Analysis

Bearman

Abbas

Masroor

et al. 2018

Infect. Control Hosp. Epidemiol.

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Single-center, quasi-experimental study conducted between 2011 and 2016.METHODSWe 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.RESULTSThe 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.CONCLUSIONThe 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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Section: Discussionmentioning

confidence: 99%

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Impact of Discontinuing Contact Precautions for Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcus: An Interrupted Time Series Analysis

Bearman

Abbas

Masroor

et al. 2018

Infect. Control Hosp. Epidemiol.

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“…While CPs are recommended by the Centers for Disease Control and Prevention when caring for patients infected with certain multidrug‐resistant organisms (Siegel et al. ), those calling for an end to CPs cite their low adherence and high cost while questioning their efficacy in preventing transmission (Morgan, Wenzel, and Bearman ). Others, however, caution that premature discontinuation of CPs may lead to an increase in infections (Rubin, Samore, and Harris ).…”

Section: Discussionmentioning

confidence: 99%

“…A recent debate in the infection control community centers around the value of contact precautions (CPs), the use of gloves and gowns by providers when caring for patients in a health care facility to prevent transmission of infectious organisms. While CPs are recommended by the Centers for Disease Control and Prevention when caring for patients infected with certain multidrug-resistant organisms (Siegel et al 2007), those calling for an end to CPs cite their low adherence and high cost while questioning their efficacy in preventing transmission (Morgan, Wenzel, and Bearman 2017). Others, however, caution that premature discontinuation of CPs may lead to an increase in infections (Rubin, Samore, and Harris 2018).…”

Section: Discussionmentioning

confidence: 99%

The Impact of Healthcare‐Associated Methicillin‐Resistant Staphylococcus aureus Infections on Postdischarge Health Care Costs and Utilization across Multiple Health Care Systems

Nelson

Jones

Liu

et al. 2018

Health Services Research

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Objective To measure how much of the postdischarge cost and utilization attributable to methicillin‐resistant Staphylococcus aureus (MRSA) health care‐associated infections (HAIs) occur within the US Department of Veterans Affairs (VA) system and how much occurs outside. Data Sources/Study Setting Health care encounters from 3 different settings and payment models: (1) within the VA; (2) outside the VA but paid for by the VA (purchased care); and (3) outside the VA and paid for by Medicare. Study Design Historical cohort study using data from admissions to VA hospitals between 2007 and 2012. Methods We assessed the impact of a positive MRSA test result on costs and utilization during the 365 days following discharge using inverse probability of treatment weights to balance covariates. Principal Findings Among a cohort of 152,687 hospitalized Veterans, a positive MRSA test result was associated with an overall increase of 6.6 (95 percent CI: 5.7–7.5) inpatient days and $9,237 (95 percent CI: $8,211–$10,262) during the postdischarge period. VA inpatient admissions, Medicare reimbursements, and purchased care payments accounted for 60.6 percent, 22.5 percent, and 16.9 percent of these inpatient costs. Conclusions While most of the excess postdischarge health care costs associated with MRSA HAIs occurred in the VA, non‐VA costs make up an important subset of the overall burden.

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Contact Precautions for Multidrug-Resistant Organisms

Peterson

2017

JAMA

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scale scores. We described 3 primary outcomes in our study protocol (pain, global perceived effect, and functional status) and presented pain as the primary outcome in the article because the sample size calculation was based on this outcome. Global perceived effect and functional status were presented together with other secondary outcomes. In the study protocol, an MCID in pain was predefined as 2 or more points on the 11-point numeric rating scale. In light of the aim of the study, it is not the change but the difference that is important. All parties involved in this study (including the Dutch Society of Anesthesiology and the patient representatives) agreed with this outcome. We included post hoc analyses in which we compared the percentage of individual patients fulfilling the predefined improvement of 2 or more points or a 30% pain reduction in the intervention and control groups. Both analyses showed similar results as the primary analysis.Rimmalapudi and colleagues considered the control intervention impractical. Exercise therapy is recommended in the Dutch clinical guidelines for chronic low back pain and reflects usual care for this patient population.Rimmalapudi and colleagues are also critical about a possible conflict of interest. The study was funded by the Dutch health insurance companies, the Netherlands Organization for Health Research, and the Dutch Society for Anesthesiology. There was extensive communication throughout all stages of the study. Conflict of interest, if present, would be balanced among these parties. Furthermore, the health insurance companies had no involvement in the design, analysis, and interpretation of the study.

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Contact Precautions for Endemic MRSA and VRE

Cited by 64 publications

References 9 publications

Impact of Discontinuing Contact Precautions for Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcus: An Interrupted Time Series Analysis

Impact of Discontinuing Contact Precautions for Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcus: An Interrupted Time Series Analysis

The Impact of Healthcare‐Associated Methicillin‐Resistant Staphylococcus aureus Infections on Postdischarge Health Care Costs and Utilization across Multiple Health Care Systems

Contact Precautions for Multidrug-Resistant Organisms

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