The discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: Impact upon patient adverse events and hospital operations

Abstract

BackgroundContact precautions for endemic methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) are a resource-intensive intervention to reduce healthcare-associated infections, potentially impeding patient throughput and limiting bed availability to isolate other contagious pathogens. We investigated the impact of the discontinuation of contact precautions (DcCP) for endemic MRSA and VRE on patient outcomes and operations metrics in an acute care setting.MethodsThis is a retrospective, quasi-experimental analysis of the 12 months before and after DcCP for MRSA and VRE at an academic medical centre. The frequency for bed closures due to contact isolation was measured, and personal protective equipment (PPE) expenditures and patient satisfaction survey results were compared using the Wilcoxon signed-rank test. Using an interrupted time series design, emergency department (ED) admission wait times and rates of patient falls, pressure ulcers and nosocomial MRSA and VRE clinical isolates were compared using GEEs.ResultsPrior to DcCP, bed closures for MRSA and/or VRE isolation were associated with estimated lost hospital charges of $9383 per 100 bed days (95% CI: 8447 to 10 318). No change in ED wait times or change in trend was observed following DcCP. There were significant reductions in monthly expenditures on gowns (−61.0%) and gloves (−16.3%). Patient satisfaction survey results remained stable. No significant changes in rates or trends were observed for patient falls or pressure ulcers. Incidence rates of nosocomial MRSA (1.58 (95% CI: 0.82 to 3.04)) and VRE (1.02 (95% CI: 0.82 to 1.27)) did not significantly change.ConclusionsDcCP was associated with an increase in bed availability and revenue recovery, and a reduction in PPE expenditures. Benefits for other hospital operations metrics and patient outcomes were not identified.

Considering the precautionary principle and its application to MRSA and SARS-CoV-2 as emerging novel pathogens of their time

“…[4][5][6] Despite this, CP are now widely implemented worldwide 2 , even though there is little evidence that they are more effective than standard IPC precautions (including antimicrobial stewardship, hand hygiene, environmental and equipment cleaning, and aseptic technique) 7 in preventing MRSA acquisitions and infections in hospital. [8][9][10]…”

“…31 Similarly, the aggregated financial costs of the application of CP for the management of MRSA will have been significant. 8,10 Whilst the environmental impact of the PPE required for CP had not previously attracted attention, the environmental impact of PPE manufacture, supply and disposal has recently been noted. 32 Crucially, whilst SARS-CoV-2 control measures have likely reduced COVID-19 hospitalisations, and deaths, 12 strong evidence for the efficacy of CP in preventing MRSA transmission does not exist.…”

“…32 Crucially, whilst SARS-CoV-2 control measures have likely reduced COVID-19 hospitalisations, and deaths, 12 strong evidence for the efficacy of CP in preventing MRSA transmission does not exist. 8,33 When CP are relaxed there is no significant increase in MRSA infections or colonisations. 8,34,35…”

Realist analysis of streaming interventions in emergency departments

“…The study concluded that effective interventions link a defined population to appropriate capacity through an efficient process: ineffective interventions were found to have neglected one or more of these three crucial aspects. The model is gaining currency [21][22][23] but has not yet been applied to in-depth analysis of a family of interventions.…”

Evaluation of Patients’ Adverse Events During Contact Isolation for Vancomycin-Resistant Enterococci Using a Matched Cohort Study With Propensity Score

“…10 With this concern, several studies have reported no significantly increased incidence of MDRO after discontinuation of contact isolation with horizontal infection control interventions such as daily chlorhexidine gluconate bathing. [11][12][13] Subsequent studies also reported higher incidences of adverse events among contact isolation patients using different study designs such as retrospective cohort, 14 observational quasi-experimental, 15 and propensity score-matched cohort. 16 Conversely, few studies provided counterevidence that contact isolation patients were less likely to experience preventable adverse events.…”