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Background
The 2007 Centers for Disease Control and Infection (CDC) Guideline on Preventing Transmission
of Infectious Agents in Healthcare Settings emphasized contact precautions as a key
strategy to reduce transmission of multidrug resistant organisms (MDROs). To ensure
that contact precautions are initiated at hospitalization, a flag is automatically
generated in the electronic medical record (EMR) for patients positive for selected
MDROs. The majority of these flags are for Methicillin resistant staphylococcus aureus
(MRSA) and Vancomycin resistant enterococci (VRE). Recently the value of isolation
for endemic MRSA and VRE has been questioned and some institutions have discontinued
contact precautions for these organisms. Many states still have laws that mandate
active surveillance and isolation for MRSA. To decrease burden of unnecessary isolation,
Infection Prevention and Control (IPAC) implemented a process to review and manage
the isolation flag in the EMR.
Methods
A process for flag removal was outlined in 2012. IPAC called the medical team on select
patients and recommended testing to facilitate flag removal. The process was time
intensive and recommendations were not followed consistently. Quality improvement
tools, including value stream mapping and time studies were used to identify improvement
opportunities. This resulted in creation of a nursing protocol released in tandem
with the new EMR in May 2018. The protocol allowed infection preventionists to place
an order for repeat testing for MRSA/VRE on eligible patients.
Results
Protocol use enabled IPAC to test and remove 604 MRSA and/or VRE flags between May
2018 and November 2019. Prior to initiation of the protocol, IPAC removed approximately
60 flags annually.
Conclusions
The EMR and nursing protocols can be leveraged to identify patients who no longer
need contact precautions. This reduces the burden of isolation in hospitals that are
not yet ready to eliminate contact precautions for MRSA and VRE.
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Article Info
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Copyright
© 2020 Published by Elsevier Inc.
