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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: [email protected]
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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.

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