Discontinuing MRSA and VRE contact precautions: Defining hospital characteristics and infection prevention practices predicting safe de-escalation

Abstract

Objective: To define conditions in which contact precautions can be safely discontinued for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Design: Interrupted time series. Setting: 15 acute-care hospitals. Participants: Inpatients. Intervention: Contact precautions for endemic MRSA and VRE were discontinued in 12 intervention hospitals and continued at 3 nonintervention hospitals. Rates of MRSA and VRE healthcare-associated infections (HAIs) were collected for 12 months before and after. Trends in HAI rates were analyzed using Poisson regression. To predict conditions when contact precautions may be safely discontinued, selected baseline hospital characteristics and infection prevention practices were correlated with HAI rate changes, stratified by hospital. Results: Aggregated HAI rates from intervention hospitals before and after discontinuation of contact precautions were 0.14 and 0.15 MRSA HAI per 1,000 patient days (P = .74), 0.05 and 0.05 VRE HAI per 1,000 patient days (P = .96), and 0.04 and 0.04 MRSA laboratory-identified (LabID) events per 100 admissions (P = .57). No statistically significant rate changes occurred between intervention and non-intervention hospitals. All successful hospitals had low baseline MRSA and VRE HAI rates and high hand hygiene adherence. We observed no correlations between rate changes after discontinuation and the assessed hospital characteristics and infection prevention factors, but the rate improved with higher proportion of semiprivate rooms (P = .04). Conclusions: Discontinuing contact precautions for MRSA/VRE did not result in increased HAI rates, suggesting that contact precautions can be safely removed from diverse hospitals, including community hospitals and those with lower proportions of private rooms. Good hand hygiene and low baseline HAI rates may be conditions permissive of safe removal of contact precautions.

Epidemiology and infection control of vancomycin-resistant enterococci at a German university hospital: A three-year retrospective cohort study

“…The authors therefore emphasize the importance of network strategies. There is also evidence in the literature that the discontinuation of contact precautions for VRE does not lead to an increase in nosocomial VRE infection rates when well-adapted infection control practices are implemented and the baseline infection rate is low [ 37 ]. In another report, however, cessation of contact precautions and active screening were associated with an increase in VRE infection rates [ 38 ].…”

Assessment of the effectiveness of ultraviolet-C disinfection on transmission of hospital-acquired pathogens from prior room occupants

“…Additionally, active surveillance for MRSA and VRE may have varied among study facilities, and in 2018, some study facilities discontinued the routine use of contact precautions for MRSA, VRE, and select non-CRE gram-negative pathogens. 19 Differences in application or adherence of active surveillance and contact precautions may affect case ascertainment and change the likelihood of transmission in the room environment. However, these are facility-level approaches, and adjusting for facility in our analysis may account for these differences.…”

Contact precautions for the control of endemic pathogens: Finding the middle path

“… 16 More recently, in an interrupted times-series analysis across 15 acute-care hospitals, the discontinuation of contact precautions resulted in no healthcare-associated infection rate increases. 17 In the recent editorial published in the Journal of Infection Prevention , Wilson and Prieto 18 concluded that the incremental benefit of contact precautions beyond standard precautions for the control of endemic pathogens is lacking and should be subjected to thorough and robust review to better define evidence-based recommendations.…”