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Discontinuing MRSA and VRE contact precautions: Defining hospital characteristics and infection prevention practices predicting safe de-escalation

Published online by Cambridge University Press:  01 December 2021

Elise M. Martin Open the ORCID record for Elise M. Martin [Opens in a new window] ,
Bonnie Colaianne ,
Christine Bridge ,
Andrew Bilderback ,
Colleen Tanner ,
Suzanne Wagester ,
Mohamed Yassin ,
Raymond Pontzer  and
Graham M. Snyder
Elise M. Martin*
Affiliation:
Department of Infection Prevention and Control, UPMC Presbyterian, Pittsburgh, Pennsylvania Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Bonnie Colaianne
Affiliation:
Wolff Center, UPMC, Pittsburgh, Pennsylvania
Christine Bridge
Affiliation:
Wolff Center, UPMC, Pittsburgh, Pennsylvania
Andrew Bilderback
Affiliation:
Wolff Center, UPMC, Pittsburgh, Pennsylvania
Colleen Tanner
Affiliation:
Department of Quality, UPMC Passavant, Pittsburgh, Pennsylvania
Suzanne Wagester
Affiliation:
Wolff Center, UPMC, Pittsburgh, Pennsylvania
Mohamed Yassin
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Department of Infection Prevention and Control, UPMC Mercy, Pittsburgh, Pennsylvania
Raymond Pontzer
Affiliation:
Department of Infection Prevention and Control, UPMC St. Margaret, Pittsburgh, Pennsylvania
Graham M. Snyder
Affiliation:
Department of Infection Prevention and Control, UPMC Presbyterian, Pittsburgh, Pennsylvania Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
*
Author for correspondence: Elise M. Martin, MD, MS, Falk Medical Building, 3601 Fifth Ave, Suite 150, Pittsburgh, PA15213. E-mail: emm207@pitt.edu
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Abstract

Objective:

To define conditions in which contact precautions can be safely discontinued for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE).

Design:

Interrupted time series.

Setting:

15 acute-care hospitals.

Participants:

Inpatients.

Intervention:

Contact precautions for endemic MRSA and VRE were discontinued in 12 intervention hospitals and continued at 3 nonintervention hospitals. Rates of MRSA and VRE healthcare-associated infections (HAIs) were collected for 12 months before and after. Trends in HAI rates were analyzed using Poisson regression. To predict conditions when contact precautions may be safely discontinued, selected baseline hospital characteristics and infection prevention practices were correlated with HAI rate changes, stratified by hospital.

Results:

Aggregated HAI rates from intervention hospitals before and after discontinuation of contact precautions were 0.14 and 0.15 MRSA HAI per 1,000 patient days (P = .74), 0.05 and 0.05 VRE HAI per 1,000 patient days (P = .96), and 0.04 and 0.04 MRSA laboratory-identified (LabID) events per 100 admissions (P = .57). No statistically significant rate changes occurred between intervention and non-intervention hospitals. All successful hospitals had low baseline MRSA and VRE HAI rates and high hand hygiene adherence. We observed no correlations between rate changes after discontinuation and the assessed hospital characteristics and infection prevention factors, but the rate improved with higher proportion of semiprivate rooms (P = .04).

Conclusions:

Discontinuing contact precautions for MRSA/VRE did not result in increased HAI rates, suggesting that contact precautions can be safely removed from diverse hospitals, including community hospitals and those with lower proportions of private rooms. Good hand hygiene and low baseline HAI rates may be conditions permissive of safe removal of contact precautions.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 11 , November 2022 , pp. 1595 - 1602
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION. The data in this manuscript were presented in part as an oral presentation at the Top Oral Abstracts session at the SHEA Spring 2019 Conference: Science Guiding Prevention on April 24–26, 2019, in Boston, Massachusetts.

References

Morgan, DJ, Murthy, R, Munoz-Price, LS, et al. Reconsidering contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus . Infect Control Hosp Epidemiol 2015;36:1163–1172.Google ScholarPubMed
Calfee, DP, Salgado, CD, Milstone, AM, et al. Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute-care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:772–796.CrossRefGoogle ScholarPubMed
Fatkenheuer, G, Hirschel, B, Harbarth, S. Screening and isolation to control meticillin-resistant Staphylococcus aureus: sense, nonsense, and evidence. Lancet 2015;385:1146–1149.CrossRefGoogle ScholarPubMed
Morgan, DJ, Kaye, KS, Diekema, DJ. Reconsidering isolation precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus . JAMA 2014;312:1395–1396.CrossRefGoogle ScholarPubMed
Harris, AD, Pineles, L, Belton, B, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA 2013;310:1571–1580.Google ScholarPubMed
Bearman, GM, Marra, AR, Sessler, CN, et al. A controlled trial of universal gloving versus contact precautions for preventing the transmission of multidrug-resistant organisms. Am J Infect Control 2007;35:650–655.CrossRefGoogle ScholarPubMed
Derde, LP, Cooper, BS, Goossens, H, et al. Interventions to reduce colonisation and transmission of antimicrobial-resistant bacteria in intensive care units: an interrupted time series study and cluster randomised trial. Lancet Infect Dis 2014;14:31–39.CrossRefGoogle ScholarPubMed
Harbarth, S, Fankhauser, C, Schrenzel, J, et al. Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA 2008;299:1149–1157.CrossRefGoogle ScholarPubMed
Huang, SS, Yokoe, DS, Hinrichsen, VL, et al. Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2006;43:971–978.CrossRefGoogle ScholarPubMed
Huskins, WC, Huckabee, CM, O’Grady, NP, et al. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 2011;364:1407–1418.CrossRefGoogle ScholarPubMed
Jain, R, Kralovic, SM, Evans, ME, et al. Veterans’ Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011;364:1419–1430.Google Scholar
Lucet, JC, Paoletti, X, Lolom, I, et al. Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med 2005;31:1051–1057.Google ScholarPubMed
Marshall, C, Richards, M, McBryde, E. Do active surveillance and contact precautions reduce MRSA acquisition? A prospective interrupted time series. PLoS One 2013;8:e58112.CrossRefGoogle ScholarPubMed
Robicsek, A, Beaumont, JL, Paule, SM, et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008;148:409–418.CrossRefGoogle ScholarPubMed
Khader, K, Thomas, A, Stevens, V, et al. Association between contact precautions and transmission of methicillin-resistant Staphylococcus aureus in Veterans’ Affairs hospitals. JAMA Netw Open 2021;4:e210971.CrossRefGoogle Scholar
De Angelis, G, Cataldo, MA, De Waure, C, et al. Infection control and prevention measures to reduce the spread of vancomycin-resistant enterococci in hospitalized patients: a systematic review and meta-analysis. J Antimicrob Chemother 2014;69:1185–1192.Google ScholarPubMed
Dashiell-Earp, CN, Bell, DS, Ang, AO, Uslan, DZ. Do physicians spend less time with patients in contact isolation? A time-motion study of internal medicine interns. JAMA Intern Med 2014;174:814–815.CrossRefGoogle ScholarPubMed
Evans, HL, Shaffer, MM, Hughes, MG, et al. Contact isolation in surgical patients: a barrier to care? Surgery 2003;134:180–188.CrossRefGoogle ScholarPubMed
Masse, V, Valiquette, L, Boukhoudmi, S, et al. Impact of methicillin resistant Staphylococcus aureus contact isolation units on medical care. PLoS One 2013;8:e57057.CrossRefGoogle ScholarPubMed
Morgan, DJ, Pineles, L, Shardell, M, et al. The effect of contact precautions on healthcare worker activity in acute-care hospitals. Infect Control Hosp Epidemiol 2013;34:69–73.CrossRefGoogle ScholarPubMed
Saint, S, Higgins, LA, Nallamothu, BK, Chenoweth, C. Do physicians examine patients in contact isolation less frequently? A brief report. Am J Infect Control 2003;31:354–356.CrossRefGoogle ScholarPubMed
Stelfox, HT, Bates, DW, Redelmeier, DA. Safety of patients isolated for infection control. JAMA 2003;290:1899–1905.CrossRefGoogle ScholarPubMed
Gilligan, P, Quirke, M, Winder, S, Humphreys, H. Impact of admission screening for methicillin-resistant Staphylococcus aureus on the length of stay in an emergency department. J Hosp Infect 2010;75:99–102.Google Scholar
McLemore, A, Bearman, G, Edmond, MB. Effect of contact precautions on wait time from emergency room disposition to inpatient admission. Infect Control Hosp Epidemiol 2011;32:298–299.Google ScholarPubMed
Goldszer, RC TE, Yokoe, DS, Shadick, N, et al. A program to remove patients from unnecessary contact precautions. J Clin Outcomes Manag 2002;9:553–556.Google Scholar
Day, HR, Morgan, DJ, Himelhoch, S, Young, A, Perencevich, EN. Association between depression and contact precautions in veterans at hospital admission. Am J Infect Control 2011;39:163–165.CrossRefGoogle ScholarPubMed
Mehrotra, P, Croft, L, Day, HR, et al. Effects of contact precautions on patient perception of care and satisfaction: a prospective cohort study. Infect Control Hosp Epidemiol 2013;34:1087–1093.CrossRefGoogle ScholarPubMed
Karki, S, Leder, K, Cheng, AC. Patients under contact precautions have an increased risk of injuries and medication errors: a retrospective cohort study. Infect Control Hosp Epidemiol 2013;34:1118–1120.CrossRefGoogle ScholarPubMed
Croft, LD, Liquori, M, Ladd, J, et al. The effect of contact precautions on frequency of hospital adverse events. Infect Control Hosp Epidemiol 2015;36:1268–1274.CrossRefGoogle ScholarPubMed
Martin, EM, Russell, D, Rubin, Z, 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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Bearman, G, Abbas, S, Masroor, N, 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.CrossRefGoogle ScholarPubMed
Marra, AR, Edmond, MB, Schweizer, ML, Ryan, GW, Diekema, DJ. Discontinuing contact precautions for multidrug-resistant organisms: a systematic literature review and meta-analysis. Am J Infect Control 2018;46:333–340.CrossRefGoogle ScholarPubMed
Schrank, GM, Snyder, GM, Davis, RB, Branch-Elliman, W, Wright, SB. The discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: impact upon patient adverse events and hospital operations. BMJ Qual Saf 2019. doi: 10.1136/bmjqs-2018-008926.Google ScholarPubMed
Haessler, S, Martin, EM, Scales, ME, et al. Stopping the routine use of contact precautions for management of MRSA and VRE at three academic medical centers: an interrupted time series analysis. Am J Infect Control 2020;48:1466–1473.CrossRefGoogle ScholarPubMed
Martin, EM, Bryant, B, Grogan, TR, et al. Noninfectious hospital adverse events decline after elimination of contact precautions for MRSA and VRE. Infect Control Hosp Epidemiol 2018;39:788–796.CrossRefGoogle ScholarPubMed
Standard precautions for all patient care. Centers for Disease Control and Prevention website. https://www.cdc.gov/infectioncontrol/basics/standard-precautions.html. Published 2016. Accessed May 11, 2021.Google Scholar
Five moments for hand hygiene. World Health Organization website. https://www.who.int/gpsc/tools/Five_moments/en/. Published 2019. Accessed October 21, 2019.Google Scholar
CDC/NHSN surveillance definitions for specific types of infections. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf. Published 2021. Accessed April 26, 2021.Google Scholar
Multidrug-resistant organism and Clostridioides difficile infection (MDRO/CDI) Module. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/12pscmdro_cdadcurrent.pdf. Published 2021. Accessed May 11, 2021.Google Scholar