infection control & hospital epidemiology july 2018, vol. 39, no. 7 original article
Noninfectious Hospital Adverse Events Decline After Elimination of Contact Precautions for MRSA and VRE
Elise M. Martin, MD, MS;1 Brandy Bryant, MPH;2 Tristan R. Grogan, MS;3 Zachary A. Rubin, MD;1 Dana L. Russell, MPH;4 David Elashoff, PhD;3 Daniel Z. Uslan, MD, MBA, FIDSA, FSHEA1
objective. To evaluate the impact of discontinuing routine contact precautions (CP) for endemic methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) on hospital adverse events.
design. Retrospective, nonrandomized, observational, quasi-experimental study. setting. Academic medical center with single-occupancy rooms. participants. Inpatients.
methods. We compared hospital reportable adverse events 1 year before and 1 year after discontinuation of routine CP for endemic MRSA and VRE (preintervention and postintervention periods, respectively). Throughout the preintervention period, daily chlorhexidine gluconate bathing was expanded to nearly all inpatients. Chart reviews were performed to identify which patients and events were associated with CP for MRSA/VRE in the preintervention period as well as the patients that would have met prior criteria for MRSA/VRE CP but were not isolated in the postintervention period. Adverse events during the 2 periods were compared using segmented and mixed-effects Poisson regression models.
results. There were 24,732 admissions in the preintervention period and 25,536 in the postintervention period. Noninfectious adverse events (ie, postoperative respiratory failure, hemorrhage/hematoma, thrombosis, wound dehiscence, pressure ulcers, and falls or trauma) decreased by 19% (12.3 to 10.0 per 1,000 admissions, P=.022) from the preintervention to the postintervention period. There was no significant difference in the rate of infectious adverse events after CP discontinuation (20.7 to 19.4 per 1,000 admissions, P=.33). Patients with MRSA/VRE showed the largest reduction in noninfectious adverse events after CP discontinuation, with a 72% reduction (21.4 to 6.08 per 1,000 MRSA/VRE admissions; P<.001).
conclusion. After discontinuing routine CP for endemic MRSA/VRE, the rate of noninfectious adverse events declined, especially in patients who no longer required isolation. This suggests that elimination of CP may substantially reduce noninfectious adverse events.
Infect Control Hosp Epidemiol 2018;39:788–796
Although both the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America still recommend contact precautions (CP) to decrease the trans- mission of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) in acute-care hospitals, recent data have indicated a need to question whe- ther this should remain the standard of care.1–8 Several institutions have eliminated routine CP for MRSA
and VRE; instead, they solely employ horizontal infection prevention strategies to decrease spread of resistant organisms, such as improved hand hygiene and targeted or universal decolonization with products like chlorhexidine gluconate
(CHG).3,6–8 Three studies specifically looking at infectious outcomes of removing routine CP have reported no increase in infectious complications, such as device-associated infections, MRSA acquisitions, MRSA environmental contamination, and healthcare-associated infections with MRSA and/or VRE.6–8 Although some data support CP in combination with other horizontal strategies, data on gowns and gloves alone are lacking.3,9–20 Multiple studies have shown potential patient harms asso-
ciated with the use of CP, including increased preventable adverse events, such as falls, pressure ulcers, medication administration errors, and deep vein thrombosis.21–23 CP have
Affiliations: 1. Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California; 2. Department of Quality Management,
UCLA Health, Los Angeles, California; 3. Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, California; 4. Clinical Epidemiology and Infection Prevention, UCLA Health, Los Angeles, California.
PREVIOUS PRESENTATION. The data in this manuscript were presented in part (Poster no. 616) at the SHEA Spring 2016 conference: Science Guiding Prevention, in Atlanta, Georgia, on May 20, 2016.
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2018/3907-0004. DOI: 10.1017/ice.2018.93 Received January 8, 2018; accepted March 10, 2018; electronically published May 10, 2018
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