The Impact of Discontinuing Contact Precautions for VRE and MRSA on Device-Associated Infections

Edmond, Michael B.; Masroor, Nadia; Stevens, Michael P.; Ober, Janis; Bearman, Gonzalo

doi:10.1017/ice.2015.99

Cited by 50 publications

(35 citation statements)

References 8 publications

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“…Recent studies suggest that colonization with MRSA and VRE may be short-lived, even in the event of a recent infection, 8 and several have questioned the potential for nosocomial transmission. 4,7,9 In a randomized multicenter study, a universal glove and gown strategy for ICU patients did not impact the primary outcome of combined MRSA and VRE acquisition rates. 4 When employing a universal gloving and gowning strategy, more than 300 patient encounters may be required to prevent a single instance of MRSA acquisition.…”

Section: Discussionmentioning

confidence: 96%

“…10 Gown and glove use is associated with significant cost for PPE. 1,7 Several prior studies have reported substantial cost savings after the discontinuation of contact precautions for MRSA-and VRE-infected or -colonized patients. 7,11 One quasi-experimental before-and-after study demonstrated that discontinuation of contact precautions for MRSA and VRE may decrease isolation days by 45% and healthcare costs by up to $622,405 annually.…”

Section: Discussionmentioning

confidence: 99%

“…1,7 Several prior studies have reported substantial cost savings after the discontinuation of contact precautions for MRSA-and VRE-infected or -colonized patients. 7,11 One quasi-experimental before-and-after study demonstrated that discontinuation of contact precautions for MRSA and VRE may decrease isolation days by 45% and healthcare costs by up to $622,405 annually. 9 Contact precautions for MRSA and VRE are still widely implemented, with no consensus regarding the best practice.…”

Section: Discussionmentioning

confidence: 99%

“…3,8 Policies vary from active surveillance and isolation for MRSA and VRE to universal decolonization with or without contact precautions, universal gloving and gowning in ICUs, and discontinuation of contact precautions except in select circumstances (eg, open or draining wounds, infectious diarrhea, and outbreak control). 4,7,9,[11][12][13] Contact precautions were previously used at our institution for all patients infected or colonized with MRSA and/or VRE. This policy was revised in 2013, and afterward patients were isolated only if they had draining wounds not containable by a bandage that were positive for these organisms.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

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: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…3 One study showed no increase in device-associated HAI rates after discontinuing CP for MRSA/VRE. 32 …”

Section: Introductionmentioning

confidence: 99%

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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Contact Precautions for Endemic MRSA and VRE

Morgan

Wenzel

Bearman

2017

JAMA

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The Impact of Discontinuing Contact Precautions for VRE and MRSA on Device-Associated Infections

Cited by 50 publications

References 8 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

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

Contact Precautions for Endemic MRSA and VRE

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