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The discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: Impact upon patient adverse events and hospital operations
  1. Gregory M Schrank1,
  2. Graham M Snyder2,
  3. Roger B Davis3,
  4. Westyn Branch-Elliman4,5,6,
  5. Sharon B Wright6,7,8
  1. 1Department of Medicine, Division of Infectious Diseases, University of Maryland Medical Center, Baltimore, Maryland, United States
  2. 2Department of Infection Prevention and Control, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  3. 3Department of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  4. 4Department of Medicine, Section of Infectious Diseases, VA Boston Healthcare System, West Roxbury, Massachusetts, United States
  5. 5VA Boston Center for Healthcare Organization and Implementation Research, Boston, Massachusetts, United States
  6. 6Harvard Medical School, Boston, Massachusetts, United States
  7. 7Division of Infection Control/Hospital Epidemiology, Silverman Institute of Health Care Quality & Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  8. 8Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  1. Correspondence to Dr Gregory M Schrank, Department of Medicine, University of Maryland Medical Center, Baltimore, MD 21201, USA; gschrank{at}som.umaryland.edu

Abstract

Background Contact 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.

Methods This 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.

Results Prior 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.

Conclusions DcCP 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.

  • contact precautions
  • methicillin-resistantstaphylococcus aureus
  • vancomycin-resistantenterococcus
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Footnotes

  • Contributors All authors were involved in the interpretation of the data. All authors were involved in the revisions and approval of the final manuscript for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Data utilised for these analyses were collected as part of routine infection control surveillance, quality improvement and patient safety initiatives, and for the purposes of hospital operations. The study was determined to be exempt by the Beth Israel Deaconess Medical Center Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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