Does the removal of contact precautions for MRSA and VRE infected patients change health care-associated infection rate?: A systematic review and meta-analysis

Abstract

Objective: Update existing meta-analysis to analyze if discontinuation of contact precautions (CPs) for Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin resistant Enterococcus (VRE) colonization or infection affects hospital-associated MRSA or VRE infection rates. Methods: We conducted a systematic review of 17 studies evaluating discontinuation of CPs for MRSA and VRE. Random-effects and fixed-effects models were used to determine the pooled risk ratios (RR) of preincidence hospital-associated infection rate to postincidence rate. Subgroup analysis was used to assess sources of heterogeneity. Results: No significant difference between rates of hospital-associated MRSA infection before and after stopping the CPs was observed (RR, 0.84; 95% confidence internal [CI], 0.71-1.01; P = .06). An inverse association was observed between discontinuation of CPs and rates of hospital-associated VRE infection (RR, 0.82; 95% CI, 0.72-0.94; P = .005). A subgroup analysis of 6 studies that used chlorhexidine, showed no difference between rates of hospital-associated MRSA infection with discontinuation of CPs (RR, 0.83; 95% CI, 0.69-1.00; P = .05). In 5 studies that did not use chlorhexidine, there was no difference between rates of hospital-associated MRSA infection with discontinuation of CPs (RR, 1.02; 95% CI, 0.55-1.88; P= .95). Conclusions: There was no significant difference in rates of hospital-associated MRSA infection before and after removing CPs. Additionally, there were decreased rates of hospital-associated VRE infection following stoppage of CPs.

Impact of discontinuing contact precautions and enforcement of basic hygiene measures on nosocomial vancomycin-resistant Enterococcus faecium transmission

“…Compared with baseline, discontinuation of contact precautions was not associated with an increase of VREfm bacteraemia incidence density in our study setting. Our findings are consistent with other studies that also did not observed an increase in VRE infection rates after contact precautions were discontinued (11,18,19). Furthermore, we did not observe significant changes to the overall VREfm cases, which includes both colonization and infection, following discontinuation of contact precautions for patients colonized or infected by VREfm in the time series analysis.…”

“…Although some data on the impact of contact precautions for VREfm have been published, most studies focus on infection rates as a primary outcome (10,11). The effect of IPC change on nosocomial VREfm transmission events is not yet adequately investigated.…”

Long-term impact of contact precautions cessation for Methicillin-Resistant Staphylococcus Aureus (MRSA)

“…More evidence is emerging that CP do not decrease MRSA associated HAIs (5). After discontinuing CP for MRSA in 09/2015 we used an interrupted time series analysis approach to evaluate the impact of this intervention on MRSA associated HAI over close to three years.…”

“…The Centers for Disease Control and Prevention (CDC) recommends the implementation of Contact Precautions (CP) to control and prevent cross-transmission between patients with MRSA (4). However, this costly and time-consuming practice lags strong evidence (5)(6)(7)(8)(9)(10)(11)(12).…”

“…Several retrospective and prospective studies were published debating CP effectiveness and supporting the discontinuation of CP for MRSA (8,(14)(15)(16). Some US hospitals have discontinued the use of CP for MRSA in their facilities (5,6). The primary objective of our study was to assess the impact of discontinuation of CP for MRSA on MRSA associated infection rates over an extended time period in a tertiary care university hospital.…”