Advertisement

The impact of discontinuing contact precautions for multidrug resistant organisms at a less than 400-bed level II teaching hospital and a community hospital: A 3-month pilot study

Published:September 10, 2019DOI:https://doi.org/10.1016/j.ajic.2019.08.012

      Background

      The impact of discontinuing contact precautions (CPs) for patients with select multidrug-resistant organisms on bacteremia infection rates was evaluated in this quality improvement project.

      Methods

      The removal of use of CPs, with increased focus on standard precautions, for all patients with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) colonization/infection was piloted via a quality improvement project over a 3-month period.

      Results

      CP was discontinued in December 2018. Comparing 3 months pre- and postchange, the overall incidence density rate decreased for hospital-onset (HO) laboratory-identified (LabID) MRSA bacteremia (0.07 vs 0.02; P = .52), whereas HO LabID VRE bacteremia rates remained the same (0.00 vs 0.00). Overall estimated financial savings, including personal protective equipment ($15,375) and staff time ($17,165), was $32,540 for the project period, with annualized estimated savings of $130,160.

      Conclusions

      In this pilot study evaluating the discontinuance of CPs, there was no evidence of an increase in HO MRSA or VRE LabID bacteremia incidence density rates. This practice change may be safely implemented at similar health care facilities.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bardossy AC
        • Alsafadi MY
        • Starr P
        • Chami E
        • Pietsch J
        • Moreno D
        • et al.
        Evaluation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus.
        Am J Infect Control. 2017; 45: 1369-1371
        • Bearman G
        • Abba S
        • Masroor N
        • Sanogo K
        • Vanhoozer G
        • Cooper K
        • et al.
        Impact of discontinuing contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: an interrupted time series analysis.
        Infect Control Hosp Epidemiol. 2018; 39: 676-682
        • Edmond MB
        • Masroor N
        • Stevens MP
        • Ober J
        • Bearman G
        The impact of discontinuing contact precautions for VRE and MRSA on device-associated infections.
        Infect Control Hosp Epidemiol. 2015; 36: 978-980
        • Martin EM
        • Bryant B
        • Grogan TR
        • Rubin ZA
        • Russell DL
        • Elashoff D
        • et al.
        Noninfectious hospital adverse events decline after elimination of contact precautions for MRSA and VRE.
        Infect Control Hosp Epidemiol. 2018; 39: 788-796
        • Renaudin L
        • Llorens M
        • Goetz C
        • Gette S
        • Citro V
        • Poulain S
        • et al.
        Impact of discontinuing contact precautions for MRSA and ESBLE in an intensive care unit: a prospective noninferiority before and after study.
        Infect Control Hosp Epidemiol. 2017; 38: 1342-1350
        • Morgan DJ
        • Diekema DJ
        • Sepkowitz K
        • Perencevich EN
        Adverse outcomes associated with contact precautions: a review of the literature.
        Am J Infect Control. 2009; 37: 85-93
        • Pogorzelska-Maziarz M
        • Gilmartin H
        • Reese S
        Infection prevention staffing and resources in US acute care hospitals: results from the APIC mega survey.
        Am J Infect Control. 2018; 46: 852-857
        • VerLee K
        • Berriel-Cass D
        • Buck K
        • Nguyen C
        Cost of isolation: daily cost of isolation determined and cost avoidance demonstrated from the overuse of personal protective equipment in an acute care facility.
        Am J Infect Control. 2014; 42: 448-449
        • Almyroudis NG
        • Osawa R
        • Samonis G
        • Wetzler M
        • Wang ES
        • McCarthy PL
        • et al.
        Discontinuation of systematic surveillance and contact precautions for vancomycin-resistant Enterococcus (VRE) and its impact on the incidence of VRE faecium bacteremia in patients with hematologic malignancies.
        Infect Control Hosp Epidemiol. 2016; 37: 398-403
        • Gandra S
        • Barysauskas CM
        • Mack DA
        • Barton B
        • Finberg R
        • Ellison RT
        Impact of contact precautions on falls, pressure ulcers and transmission of MRSA and VRE in hospitalized patients.
        J Hosp Infect. 2014; 8: 170-176
        • Marra AR
        • Edmond MB
        • Schweizer ML
        • Ryan GW
        • Diekema DJ
        Discontinuing contact precautions for multi-drug resistant organisms: a systematic literature review and meta-analysis.
        Am J Infect Control. 2018; 46: 333-340
        • Martin EM
        • Russell D
        • Rubin Z
        • Humphries R
        • Grogan TR
        • Elashoff D
        • et al.
        Elimination of routine contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: a retrospective quasi-experimental study.
        Infect Control Hosp Epidemiol. 2016; 37: 1323-1330
        • McKinnell JA
        • Eells SJ
        • Clark E
        • Rand DD
        • Macias-Gil R
        • Mendez JM
        • et al.
        Discontinuation of contact precautions with the introduction of universal daily chlorhexidine bathing.
        Epidemiol Infect. 2017; 145: 2575-2581