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Acknowledgments. Financial support. No financial support was provided relevant to this article.
Conflicts of interest. All authors report no conflicts of interest relevant to this article.
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Impact of elimination of contact precautions on noninfectious adverse events among MRSA and VRE patients
Sumanth Gandra MD1,2, Constance M. Barysauskas MS3, Deborah A. Mack RN4, Bruce Barton PhD5, Robert Finberg
MD6 and Richard T. Ellison MD6 1Medical Microbiology Fellow, Department of Pathology, University of Chicago, Chicago, Illinois, 2NorthShore University Health System, Evanston Hospital, Evanston, Illinois, 3Veristat, Southborough, Massachusetts, 4Infection Control Department, University of Massachusetts Medical Center, Worcester, Massachusetts, 5Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts and and 6Division of Infectious Disease and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts
To the Editor—We read with great interest the article by Martin et al1 published online in May 2018 in Infection Control and Hos- pital Epidemiology.1 We previously reported on the impact of elimination of contact precautions (CP) in methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enter- ococci (VRE) patients on noninfectious complications, although our analysis was limited to falls and pressure ulcers.2 Our findings dif- fered from those of Martin et al; we observed no statistically sig- nificant difference in the rate of falls or pressure ulcers among MRSA/VRE patients in the years before and after eliminating CP. The rate of falls amongMRSA/VREpatientsinthe year before eliminating CP was 4.57 per 1,000 patient days, and it was 4.82 per 1,000 patient days in the year after eliminating contact precautions (P = 074). Similarly, the rate of pressure ulcers in the year before eliminating CP was 4.87 per 1,000 patient days, and it was 4.17 per 1,000 patient days in the year after eliminating contact precautions (P = .33). Martin et al report a significant drop in the number of non- infectious adverse events among MRSA/VRE patients in the year
Author for correspondence: Sumanth Gandra MD, Room 1917, Evanston Hospital, 2650 Ridge Avenue, Evanston, IL 60201. E-mail:
gandrasatyam@gmail.com Cite this article: Gandra S, et al. (2018). Impact of elimination of contact precautions
on noninfectious adverse events among MRSA and VRE patients. Infection Control & Hospital Epidemiology 2018, 39, 1272–1273. doi: 10.1017/ice.2018.204
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
after eliminating CP (21.4 per 1000 admissions vs 6.08 per 1000 admissions; P < .001). In contrast to our study, the study sum- marized by Martin et al not only included falls and pressure ulcers but also hemorrhage, postoperative respiratory failure, wound dehiscence, and pulmonary embolism or deep vein thrombosis. Although the composite index of all noninfectious adverse events showed a significant drop, the authors did not present a break- down by individual adverse events in MRSA/VRE and non- MRSA/VRE patients. We reported 2 additional important findings in our study. First,
MRSA/VRE patients had a statistically significant higher Charlson comorbidity index (CCI) compared with non-MRSA/VRE patients (mean CCI, 3.32 vs 2.75; P = .002). This was not examined by Martin et al. Second, compared to non-MRSA/VRE patients, we found that MRSA/VRE patients had significantly higher rates of falls (4.57 per 1,000 patient days vs 2.04 per 1,000 patient days) and pressure ulcers (4.87 per 1,000 patient days vs 1.22 per 1,000 patient days), both in the year before and in the year after elim- inating CP. Based on figure 2 from Martin EM et al, the rate of noninfectious adverse events were much higher in MRSA/VRE patients than in non-MRSA/VRE patients in the year prior to elimination of CP. However, in the year thereafter, there seems to be no difference. The reason for the discrepancy in the findings between the 2 studies is
unclear.However, we have identified 2 differences between
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