Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-14T04:33:00.319Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of Contact and Droplet Precautions on the Incidence of Hospital-Acquired Methicillin-Resistant Staphylococcus aureus Infection

Published online by Cambridge University Press:  02 January 2015

Ed Mangini ,
Sorana Segal-Maurer ,
Janice Burns ,
Annette Avicolli ,
Carl Urban ,
Noriel Mariano ,
Louise Grenner ,
Carl Rosenberg  and
James J. Rahal
Ed Mangini*
Affiliation:
Infectious Diseases Section of the Department of Medicine, New York
Sorana Segal-Maurer
Affiliation:
Departments of Medicine, Weill Cornell Medical College, New York
Janice Burns
Affiliation:
Department of Nursing, New York Hospital Medical Center of Queens, Flushing, New York
Annette Avicolli
Affiliation:
Departments of Medicine, Weill Cornell Medical College, New York
Carl Urban
Affiliation:
Microbiology, Weill Cornell Medical College, New York
Noriel Mariano
Affiliation:
Infectious Diseases Section of the Department of Medicine, New York
Louise Grenner
Affiliation:
Infectious Diseases Section of the Department of Medicine, New York
Carl Rosenberg
Affiliation:
Taro Pharmaceuticals, Hawthorne, New York
James J. Rahal
Affiliation:
Departments of Medicine, Weill Cornell Medical College, New York
*
Infectious Diseases Section, Department of Medicine, New York Hospital Medical Center of Queens, 56-45 Main Street, Flushing, NY 11355 (edm9010@nyp.org)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To evaluate the efficacy of contact and droplet precautions in reducing the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections.

Design.

Before-after study.

Setting.

A 439-bed, university-affiliated community hospital.

Methods.

To identify inpatients infected or colonized with MRSA, we conducted surveillance of S. aureus isolates recovered from clinical culture and processed by the hospital's clinical microbiology laboratory. We then reviewed patient records for all individuals from whom MRSA was recovered. The rates of hospital-acquired MRSA infection were tabulated for each area where patients received nursing care. After a baseline period, contact and droplet precautions were implemented in all intensive care units (ICUs). Reductions in the incidence of hospital-acquired MRSA infection in ICUs led to the implementation of contact precautions in non-ICU patient care areas (hereafter, “non-ICU areas”), as well. Droplet precautions were discontinued. An analysis comparing the rates of hospital-acquired MRSA infection during different intervention periods was performed.

Results.

The combined baseline rate of hospital-acquired MRSA infection was 10.0 infections per 1,000 patient-days in the medical ICU (MICU) and surgical ICU (SICU) and 0.7 infections per 1,000 patient-days in other ICUs. Following the implementation of contact and droplet precautions, combined rates of hospital-acquired MRSA infection in the MICU and SICU decreased to 4.3 infections per 1,000 patient-days (95% confidence interval [CI], 0.17-0.97; P = .03). There was no significant change in hospital-acquired MRSA infection rates in other ICUs. After the discontinuation of droplet precautions, the combined rate in the MICU and SICU decreased further to 2.5 infections per 1,000 patient-days. This finding was not significant (P = .43). In the non-ICU areas that had a high incidence of hospital-acquired MRSA infection, the rate prior to implementation of contact precautions was 1.3 infections per 1,000 patient-days. After the implementation of contact precautions, the rate in these areas decreased to 0.9 infections per 1,000 patient-days (95% CI, 0.47-0.94; P = .02).

Conclusion.

The implementation of contact precautions significantly decreased the rate of hospital-acquired MRSA infection, and discontinuation of droplet precautions in the ICUs led to a further reduction. Additional studies evaluating specific infection control strategies are needed.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 11 , November 2007 , pp. 1261 - 1266
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.National Nosocomial Infections Surveillance System. National Hospital-acquired Infections Surveillance System Report, data summary from January 1992-June 2002, issued August 2002. Am J Infect Control 2002;30:458–475.CrossRefGoogle Scholar
2.Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karchmer, AW, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a metaanalysis. Clin Infect Dis 2003;36:53–59.CrossRefGoogle ScholarPubMed
3.Siegel, J, Rhinehart, E, Jackson, M, Chiarello, L, the Healthcare Infection Control Practices Advisory Group. Management of multidrug-resistant organisms in healthcare settings, 2006. Atlanta, GA: Centers for Disease Control and Prevention;2006. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf. Accessed December 10, 2006.Google Scholar
4.Pan, A, Carnevale, G, Catenazzi, P, et al. Trends in methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections: effects of the MRSA “search and isolate” strategy in a hospital with hyperendemic MRSA. Infect Control Hosp Epidemiol 2005;26:127–133.Google Scholar
5.Verhoef, J, Beaujean, HB, Baars, A, et al. A Dutch approach to methicillin-resistant Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 1999;18:461–466.Google Scholar
6.Struelens, M, Ronveaux, O, Jans, B, Mertens, R, the Groupement pour le Dépistage, l'Etude et la Prevention des Infections Hospitalières. Methicillin-resistant Staphylococcus aureus epidemiology and control in Belgian hospitals 1991 to 1995. Infect Control Hosp Epidemiol 1996;17:503–508.CrossRefGoogle ScholarPubMed
7.Jernigan, J, Clemence, A, Stott, G, et al. Control of methicillin-resistant Staphylococcus aureus at a university hospital: 1 decade later. Infect Control Hosp Epidemiol 1995;16:687–696.CrossRefGoogle Scholar
8.Muto, C, Jarvis, W, Farr, B. Another tale of 2 guidelines. Clin Infect Dis 2006;43:796–797.CrossRefGoogle Scholar
9.Strausbaugh, L, Siegel, J, Weinstein, R. Reply to Muto et al. Clin Infect Dis 2006;43:797–798.CrossRefGoogle Scholar
10.Hospital Infection Control Practices Advisory Committee (HICPAC). Management of multidrug-resistant organisms in healthcare settings, 2006. Available at: http://www.cdc.gov/ncidod/dhqp. Accessed December 10, 2006.Google Scholar
11.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. Centers for Disease Control and Prevention definitions for nosocomial infections. In: Olmstead, RN, ed. Infection Control and Applied Epidemiology: Principles and Practice. St. Louis: Mosby, 1996:A1–A20.Google Scholar
12.Garner, JS, the Hospital Infection Control Practices Advisory Committee. Guidelines for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:53–80.Google Scholar
13.Arnold, MS, Dempsey, JM, Fishman, M, et al. The best hospital practices for controlling methicillin-resistant Staphylococcus aureus: on the cutting edge. Infect Control Hosp Epidemiol 2002;23:69–76.CrossRefGoogle ScholarPubMed
14.Jernigan, JA, Titus, MG, Groschel, DH, et al. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol 1996;143:496–504.CrossRefGoogle ScholarPubMed
15.Saiman, L, Cronquist, A, Wu, F, et al. An outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2003;24:317–321.Google Scholar
16.Kirkland, KB, Weinstein, JM. Adverse effects of contact isolation. Lancet 1999;354:1177–1178.Google Scholar
17.Nijssen, S, Bonten, MJ, Weinstein, RA. Are active microbiological surveillance and subsequent isolation needed to prevent the spread of methicillin-resistant Staphylococcus aureus? Clin Infect Dis 2005;40:405–409.Google Scholar
18.Farr, B. Doing the right thing (and figuring out what that is). Infect Control Hosp Epidemiol 2006;27:999–1003.Google Scholar