adverse events and contact precautions 791 table 3. Change in the Rate of Infectious and Noninfectious Adverse Events After the Policy Change Adverse Event
Noninfectious adverse events Falls and trauma
Hemorrhage and/or hematoma Postoperative respiratory failure Wound dehiscence Pressure ulcer
Pulmonary embolism or deep vein thrombosis Infectious adverse events Hospital-onset C. difficile
Catheter-associated urinary tract infection Central-line–associated bloodstream infection Postoperative sepsis Surgical site infection
Ventilator-associated pneumonia
Preintervention Rate (Before n=24,732 admissions)a
12.3 1.1 5.5
1.42 0.1 1.2 3.0
20.7 6.5 4.0 4.4 0.4 5.2 0.2
aRate per 1,000 admissions. bBold values are statistically significant. cSlope change is the incidence rate ratio, shown with 95% confidence interval.
table 4. Change in the Rate of Noninfectious Adverse Events After the Policy Change Based on Isolation Status Isolation Status
Preintervention Ratea No isolation MRSA and/or VRE
(Before n=24,732 Admissions)b 9.9
21.4 Postintervention Ratea
(After n=25,536 Admissions)b Decrease% P Valuec 9.9
0 6.08 72
Postintervention Rate (After n=25,536 admissions)a
10.0
0.70 4.5
1.80 0.2 0.7 2.2
19.4 6.5 3.4 4.6 0.6 4.0 0.4
P Valueb .02
.16 .12 .28 .51
.053 .08 .33 .96 .30 .78 .38 .03 .17
Slope Change (95% CI)c
0.94 (0.90–0.99) 0.90 (0.76–1.06) 0.89 (0.83–0.96) 0.95 (0.83–1.09) 0.94 (0.59–1.51) 0.96 (0.81–1.14) 1.05 (0.95–1.16) 0.99 (0.95–1.02) 1.02 (0.96–1.08) 0.95 (0.88–1.03) 1.02 (0.94–1.10) 1.15 (0.93–1.43) 0.89 (0.83–0.96) 1.34 (0.99–1.83)
P Valueb .028
.21
.004 .48 .80 .64 .36 .43 .58 .23 .68 .20
.002 .06
Slope Change (95% CI)d
.99 0.94 (0.89–0.99) <.001 0.84 (0.70–1.00)
P Valuec .03
.49
NOTE. MRSA, methicillin-resistant Staphylococcus aureus; VRE, vancomycin-resistant Enterococcus. aRates are noninfectious adverse events per 1,000 admissions. bMRSA/VRE, 12% of admissions; non-MRSA/VRE, 88% of admissions. These denominators were used to calculate the respective rates. cBold values are statistically significant. dSlope change is the incidence rate ratio (with 95% confidence interval).
Statistical analyses were performed using SAS version 9.4
software (SAS Institute, Cary, NC) and SPSS version 24 soft- ware (IBM, Armonk, NY). P values<.05 were considered statistically significant.
results
Overall, there were 24,732 admissions in the preintervention period and 25,536 admissions in the postintervention period after CP discontinuation. In the preintervention period, ~12% admissions were isolated for MRSA and/or VRE, and the monthly rate remained relatively constant. No patients were isolated for MRSA/VRE in the postintervention period. Overall, 835 adverse events occurred in the preintervention period and 765 adverse events occurred in the postinterven- tion period. The events were divided into infectious and noninfectious adverse events. The demographics of patients with adverse events are displayed in Table 2. Noninfectious adverse events declined after CP dis-
continuation from 12.3 to 10.0 events per 1,000 admissions (P=.022), which is a 19% decrease in noninfectious adverse
events after 1 year. No statistically significant change in infec- tious adverse events was detected (20.7 to 19.4 adverse events per 1,000 admissions; P=.33) (Figure 1). No change in the rate of hospital adverse events was observed after the intervention. The monthly incidence rate ratio for noninfectious adverse events was 1.02 per 1,000 admissions (95% CI, 0.71–1.46; P=.913) and for infectious adverse events, the monthly incidence rate ratio was 1.31 per 1,000 admissions (95% CI, 1.00–1.71; P=.051), indicating no significant change in this rate immediately after CP discontinuation. The slope change was significant for noninfectious adverse
events and demonstrated a decrease in monthly adverse events after the CP change, with an incidence rate ratio of 0.94 adverse events per 1,000 admissions (95% CI, 0.90–0.99; P=.028) (Figure 1). No significant slope change was observed for infectious adverse events, and the monthly incidence rate ratio was 0.99 adverse events per 1,000 admissions (95% CI, 0.95–1.02; P=.43). Each adverse event in the composite end-point analysis was evaluated individually, accounting for repeated observations in
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