The Impact of Methicillin-ResistantStaphylococcus aureus(MRSA) and Vancomycin-Resistant Enterococcus (VRE) Flags on Hospital Operations

Abstract

Objective To determine the impact of MRSA/VRE designations, or flags, on selected hospital operational outcomes. Design Retrospective cohort study of inpatients admitted to the Massachusetts General Hospital during 2010–2011. Methods Operational outcomes were time to bed arrival, acuity-unrelated within-hospital transfers, and length of stay. Demographic and clinical characteristics – including age, gender, severity of illness on admission, admit day of week, residence prior to admission, hospitalization within the prior 30 days, clinical service, and discharge destination – were used as covariates. Results A total of 81,288 admissions were included. After adjusting for covariates, patients with a MRSA/VRE flag at the time of admission experienced a mean delay in time to bed arrival of 1.03 (9.63 [95% CI 9.39–9.88] hours vs. 8.60 [95% CI 8.47–8.73] hours); had 1.19 times the odds [95% CI, 1.13–1.26] of experiencing an acuity-unrelated within-hospital transfer, and experienced a mean length of stay 1.76 days longer (7.03 [95% CI 6.82–7.24] days vs. 5.27 [95% CI 5.15–5.38] days) compared to patients with no MRSA/VRE flag. Conclusions MRSA/VRE designation was associated with delays in time to bed arrival, increased likelihood of acuity-unrelated within-hospital transfers, and extended length of stay. Efforts to identify patients who have cleared MRSA/VRE colonization are critically important to mitigate inefficient use of resources and improve inpatient flow.

Prevalence of device use and transmission based precautions in nineteen large Australian acute care public hospitals: Secondary outcomes from a national healthcare associated infection point prevalence survey

“…These all have implications for scarce healthcare resources. Contact precautions have also been associated with delays in diagnostic imaging, lower patient satisfaction, prolonging hospital discharge and less frequent visits by healthcare workers [11,18,19]. As with many preventative interventions, an important factor in the effectiveness of contact precautions is healthcare worker compliance, and an inverse relationship has been demonstrated in the proportion of patients in contact precautions and healthcare worker compliance with contact precautions [13].…”

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

“…5 The discontinuation of contact precautions in acute-care settings remains controversial, with widespread variation. 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.…”

“…9 Contact precautions for MRSA and VRE are still widely implemented, with no consensus regarding the best practice. 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.…”

Defying Multidrug Resistance! Modulation of Related Transporters by Flavonoids and Flavonolignans

“…MRSA (methicillin resistant Staphylococcus aureus ) and VRE (vancomycin resistant Enterococcus faecalis ) are the only MDR Gram-positive bacteria that are intensively studied in relation with flavonoids (Table and Table ), as they cause the most challenging infections in hospitals . Many flavonoids, especially isoflavones (genistein, daidzein), but also apigenin, have been excluded for a low degree of antimicrobial activity against MDR G+ bacteria .…”

“…70,127,128 1 and Table 2), as they cause the most challenging infections in hospitals. 98 Many flavonoids, especially isoflavones (genistein, daidzein), but also apigenin, have been excluded for a low degree of antimicrobial activity against MDR G+ bacteria. 99 However, luteolin with minimal inhibitory concentration (MIC) up to 100 μM against MRSA strains is a promising candidate for further research.…”