Do Physicians Spend Less Time With Patients in Contact Isolation?

Dashiell-Earp, Cody; Bell, Douglas S.; Ang, Alexis O.; Uslan, Daniel Z.

doi:10.1001/jamainternmed.2014.537

Cited by 31 publications

(25 citation statements)

References 6 publications

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“…Numerous studies have shown that HCW spend less time directly caring for patients on CP, likely due to the burden of donning PPE. 18–23 Although it only took 38 seconds to don PPE correctly, this adds up to a substantial amount of time given how often patients are visited by HCW each day in an 805-bed health system. We estimated nursing time donning PPE over 1 year in our health system at approximately 45,000 hours, time worth an estimated $4.6 million.…”

Section: Discussionmentioning

confidence: 99%

“…Given concerning data on patient harms and no clear benefit, discontinuing routine CP for MRSA and VRE may provide substantial benefit to patients and the health system in terms of cost savings and increased time for direct patient care. 18–29 Further data are needed on the optimal hospital settings and horizontal infection prevention strategies needed for the discontinuation of CP to be successful. If CP are effective at preventing transmission of MRSA and VRE in hospitals, further data on which patient populations benefit most from the intervention would help limit universal use.…”

Section: Discussionmentioning

confidence: 99%

“…18–23 Patients experience delays in admission from the emergency room and discharge to skilled nursing facilities. 23–26 CP were also associated with increased preventable adverse events, including falls, pressure ulcers, and medication administration errors.…”

Section: Introductionmentioning

confidence: 99%

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Elimination of Routine Contact Precautions for Endemic Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcus: A Retrospective Quasi-Experimental Study

Martin

Russell

Rubin

et al. 2016

Infect. Control Hosp. Epidemiol.

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OBJECTIVE To evaluate the impact of discontinuation of contact precautions (CP) for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) and expansion of chlorhexidine gluconate (CHG) use on the health system. DESIGN Retrospective, nonrandomized, observational, quasi-experimental study. SETTING Two California hospitals. PARTICIPANTS Inpatients. METHODS We compared hospital-wide laboratory-identified clinical culture rates (as a marker of healthcare-associated infections) 1 year before and after routine CP for endemic MRSA and VRE were discontinued and CHG bathing was expanded to all units. Culture data from patients and cost data on material utilization were collected. Nursing time spent donning personal protective equipment was assessed and quantified using time-driven activity-based costing. RESULTS Average positive culture rates before and after discontinuing CP were 0.40 and 0.32 cultures/100 admissions for MRSA (P=.09), and 0.48 and 0.40 cultures/100 admissions for VRE (P=.14). When combining isolation gown and CHG costs, the health system saved $643,776 in 1 year. Before the change, 28.5% intensive care unit and 19% medicine/surgery beds were on CP for MRSA/VRE. On the basis of average room entries and donning time, estimated nursing time spent donning personal protective equipment for MRSA/VRE before the change was 45,277 hours/year (estimated cost, $4.6 million). CONCLUSION Discontinuing routine CP for endemic MRSA and VRE did not result in increased rates of MRSA or VRE after 1 year. With cost savings on materials, decreased healthcare worker time, and no concomitant increase in possible infections, elimination of routine CP may add substantial value to inpatient care delivery. Infect Control Hosp Epidemiol 2016;1-8.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Elimination of Routine Contact Precautions for Endemic Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcus: A Retrospective Quasi-Experimental Study

Martin

Russell

Rubin

et al. 2016

Infect. Control Hosp. Epidemiol.

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“…21–23 CP have also been associated with fewer healthcare provider visits, shorter healthcare provider contact time, and lack of appropriate documentation. 21,24–28 Patients can experience delays in admission from the emergency room, delays in discharge to skilled nursing facilities, and increased hospital length of stay. 21,29–32 Patients also had increased anxiety, increased depression, and lower satisfaction when compared to patients not in isolation.…”

Section: Introductionmentioning

confidence: 99%

Noninfectious Hospital Adverse Events Decline After Elimination of Contact Precautions for MRSA and VRE

Martin

Bryant

Grogan

et al. 2018

Infect. Control Hosp. Epidemiol.

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OBJECTIVETo evaluate the impact of discontinuing routine contact precautions (CP) for endemic methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) on hospital adverse events.DESIGNRetrospective, nonrandomized, observational, quasi-experimental study.SETTINGAcademic medical center with single-occupancy rooms.PARTICIPANTSInpatients.METHODSWe compared hospital reportable adverse events 1 year before and 1 year after discontinuation of routine CP for endemic MRSA and VRE (preintervention and postintervention periods, respectively). Throughout the preintervention period, daily chlorhexidine gluconate bathing was expanded to nearly all inpatients. Chart reviews were performed to identify which patients and events were associated with CP for MRSA/VRE in the preintervention period as well as the patients that would have met prior criteria for MRSA/VRE CP but were not isolated in the postintervention period. Adverse events during the 2 periods were compared using segmented and mixed-effects Poisson regression models.RESULTSThere were 24,732 admissions in the preintervention period and 25,536 in the postintervention period. Noninfectious adverse events (ie, postoperative respiratory failure, hemorrhage/hematoma, thrombosis, wound dehiscence, pressure ulcers, and falls or trauma) decreased by 19% (12.3 to 10.0 per 1,000 admissions, P=.022) from the preintervention to the postintervention period. There was no significant difference in the rate of infectious adverse events after CP discontinuation (20.7 to 19.4 per 1,000 admissions, P=.33). Patients with MRSA/VRE showed the largest reduction in noninfectious adverse events after CP discontinuation, with a 72% reduction (21.4 to 6.08 per 1,000 MRSA/VRE admissions; P<.001).CONCLUSIONAfter discontinuing routine CP for endemic MRSA/VRE, the rate of noninfectious adverse events declined, especially in patients who no longer required isolation. This suggests that elimination of CP may substantially reduce noninfectious adverse events.Infect Control Hosp Epidemiol 2018;788-796.

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“…Additionally, unintended detrimental impacts on patient care have been demonstrated. [53][54][55] No interventional study has compared MRSA or VRE acquisition rates with contact precautions versus standard precautions. Current data suggests if standard precautions are well adhered to, the incremental benefit of contact precautions is small.…”

Section: Contact Precautionsmentioning

confidence: 99%

Healthcare‐acquired infections: prevention strategies

Fernando

Gray

Gottlieb

2017

Internal Medicine Journal

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Healthcare‐acquired infections (HAI) impact on patient care and have cost implications for the Australian healthcare system. The management of HAI is exacerbated by rising rates of antimicrobial resistance (AMR). Health‐care workers and a contaminated hospital environment are increasingly implicated in the transmission and persistence of multi‐resistant organisms (MRO), as well as other pathogens, such as Clostridium difficile. This has resulted in a timely focus on a range of HAI prevention actions. Core components include antimicrobial stewardship, to reduce overuse and ensure evidence‐based antimicrobial use; infection prevention strategies, to control MRO – particularly methicillin‐resistant Staphylococcus aureus (MRSA), vancomycin‐resistant Enterococcus spp. (VRE) and, more recently, multi‐resistant Gram‐negative bacteria; enhanced institutional investment in hand hygiene; hospital cleaning and disinfection; and the development of prescribing guidelines and standards of care. AMR surveillance and comparisons of prescribing are useful feedback activities once effectively communicated to end users. Successful implementation of these strategies requires cultural shifts at local hospital level and, to tackle the serious threat posed by AMR, greater co‐ordination at a national level. HAI prevention needs to be multi‐modal, requires broad healthcare collaboration, and the strong support and accountability of all medical staff.

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Do Physicians Spend Less Time With Patients in Contact Isolation?

Cited by 31 publications

References 6 publications

Elimination of Routine Contact Precautions for Endemic Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcus: A Retrospective Quasi-Experimental Study

Elimination of Routine Contact Precautions for Endemic Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcus: A Retrospective Quasi-Experimental Study

Noninfectious Hospital Adverse Events Decline After Elimination of Contact Precautions for MRSA and VRE

Healthcare‐acquired infections: prevention strategies

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