Highlights
- •Non-use of contact precautions for MRSA or VRE did not increase HAI.
- •HAI decreased over time associated with horizontal infection prevention strategies.
- •Longitudinal multi-center interrupted time series study.
- •Outcomes were consistent across hospitals of varying size and percent single rooms.
Background
Contact precautions (CP) are a widely adopted strategy to prevent cross-transmission
of organisms, commonly methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Some hospitals have discontinued CP for patients with MRSA or VRE; however,
the impact on hospital-acquired infection rates (HAI) has not been assessed systematically.
Methods
Retrospective multicenter interrupted time series between 2002 and 2017 at three academic
hospitals. Participating hospitals discontinued CP for patients with contained body
fluids who were colonized or infected with MRSA or VRE. The primary intervention was
stopping the use of CP. Secondary interventions were horizontal infection prevention
strategies. The primary outcomes were rates of central line-associated bloodstream
infections, catheter-associated urinary tract infections, mediastinal surgical site
infection, and ventilator-associated pneumonia due to MRSA, VRE, or any organism using
Centers for Disease Control and Prevention National Healthcare Safety Network surveillance
definitions.
Results
Central line-associated bloodstream infections, catheter-associated urinary tract
infections, mediastinal surgical site infection, and ventilator-associated pneumonia
rates trended down at each institution. There were no statistically significant increases
in these infections associated with discontinuing CP. Individual horizontal infection
prevention strategies variably impacted HAI outcomes.
Conclusions
Stopping the routine use of CP for patients with contained body fluids who are colonized
or infected with MRSA or VRE did not result in increased HAIs. Bundled horizontal
infection prevention strategies resulted in sustained HAI reductions.
Key Words
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Article info
Publication history
Published online: July 04, 2020
Footnotes
Conflicts of interest: Dr. Doll reports grant funding from Molnlycke Healthcare unrelated to the presented work. Dr. Bearman reports prior research grants from: Cardinal health, Pfizer, Cardinal Healthcare, Molnycke Healthcare, BioVigil and AO Foundation. All other authors report no potential conflicts of interest.
Identification
Copyright
© 2020 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.
