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Long-Term Impact of Universal Contact Precautions on Rates of Multidrug-Resistant Organisms in ICUs: A Comparative Effectiveness Study

Published online by Cambridge University Press:  22 March 2018

E. Yoko Furuya ,
Bevin Cohen ,
Haomiao Jia  and
Elaine L. Larson
E. Yoko Furuya*
Affiliation:
Division of Infectious Diseases, Columbia University Medical Center, New York, New York Department of Infection Prevention & Control, New York-Presbyterian Hospital, New York, New York
Bevin Cohen
Affiliation:
School of Nursing, Columbia University, New York, New York Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
Haomiao Jia
Affiliation:
School of Nursing, Columbia University, New York, New York Department of Biostatitics, Mailman School of Public Health, Columbia University, New York, New York
Elaine L. Larson
Affiliation:
School of Nursing, Columbia University, New York, New York Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
*
Address correspondence to E. Yoko Furuya, MD, MS, 622 W 168th St, PH-8W #876, New York, NY 10032 ([email protected]).
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Abstract

OBJECTIVE

To evaluate the impact of universal contact precautions (UCP) on rates of multidrug-resistant organisms (MDROs) in intensive care units (ICUs) over 9 years

DESIGN

Retrospective, nonrandomized observational study

SETTING

An 800-bed adult academic medical center in New York City

PARTICIPANTS

All patients admitted to 6 ICUs, 3 of which instituted UCP in 2007

METHODS

Using a comparative effectiveness approach, we studied the longitudinal impact of UCP on MDRO incidence density rates, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and carbapenem-resistant Klebsiella pneumoniae. Data were extracted from a clinical research database for 2006–2014. Monthly MDRO rates were compared between the baseline period and the UCP period, utilizing time series analyses based on generalized linear models. The same models were also used to compare MDRO rates in the 3 UCP units to 3 ICUs without UCPs.

RESULTS

Overall, MDRO rates decreased over time, but there was no significant decrease in the trend (slope) during the UCP period compared to the baseline period for any of the 3 intervention units. Furthermore, there was no significant difference between UCP units (6.6% decrease in MDRO rates per year) and non-UCP units (6.0% decrease per year; P=.840).

CONCLUSION

The results of this 9-year study suggest that decreases in MDROs, including multidrug-resistant gram-negative bacilli, were more likely due to hospital-wide improvements in infection prevention during this period and that UCP had no detectable additional impact.

Infect Control Hosp Epidemiol 2018;39:534–540

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 5 , May 2018 , pp. 534 - 540
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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