Infection Control & Hospital Epidemiology (2019), 40, 473–475 doi:10.1017/ice.2019.19


Concise Communication


Impact of discontinuation of contact precautions on central-line associated bloodstream infections in an academic children’s hospital Emily J. Godbout DO, MPH1


MPH2, Michael P. Stevens MD, MPH2 and Gonzalo Bearman MD, MPH2 1Division of Pediatric Infectious Diseases, Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University Health System, Richmond, Virginia, 2Healthcare Infection Prevention Program, Virginia Commonwealth University Health System, Richmond, Virginia and 3Department of Pharmacy, Virginia Commonwealth University Health System, Richmond, Virginia


Abstract


We investigated the impact of discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin- resistant Enterococcus infected or colonized patients on central-line associated bloodstream infection rates at an academic children’s hospital. Discontinuation of contact precautions with a bundled horizontal infection prevention platform resulted in no adverse impact on CLABSI rates.


(Received 13 October 2018; accepted 10 January 2019)


Contact precautions (CPs) are commonly employed in pediatric populations for the control of endemic pathogens such as methi- cillin-resistant Staphylococcus aureus (MRSA) and vancomycin- resistant Enterococcus (VRE). Presumably, CPs limit infections by preventing contamination of healthcare personnel (HCP) and are often utilized to prevent hospital-associated infections (HAIs). Data on the effectiveness of CPs in reduction of HAIs in pediatric patients are scarce. Several adult studies observed that CPs negatively impact some aspects of patient care including reduced visits by HCP,1 increase rates of anxiety/depression,2,3 and increase patient dissatisfaction.4 We investigated the impact of discontinuing CPs for patients with MRSA and VRE coloniza- tion/infection on central-line associated bloodstream infections (CLABSIs) in an academic children’s hospital.


Materials and methods


This quasi-experimental, before-and-after study of discontinuing CPs for MRSA or VRE infected or colonized patients was con- ducted at the Children’s Hospital of Richmond (CHoR) at Virginia Commonwealth University Health System. CHoR is a 103-bed academic children’s hospital integrated within a larger adult facility with 40 and 21 beds for the neonatal intensive care unit (NICU) and the pediatric intensive care unit (PICU), respec- tively. PICU and NICU rooms are private, although several NICU rooms are set up to accommodate multiple births. Nearly half of the rooms in acute-care pediatrics (ACP) can accommodate dou- ble occupancy. The pediatric progressive care unit (PPCU) housed


Author for correspondence: Emily J. Godbout, Email: emily.godbout@vcuhealth.org Cite this article: Godbout EJ, et al. (2019). Impact of discontinuation of contact


precautions on central-line associated bloodstream infections in an academic children’s hospital. Infection Control & Hospital Epidemiology, 40: 473–475, https://doi.org/10.1017/ ice.2019.19


© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.


semi-private rooms and closed in January 2018 (58 months after discontinuation of CPs) to accommodate an expansion of the PICU from 14 to 21 beds. Historically, patients with multidrug- resistant organisms were placed on CPs. On April 1, 2013, we dis- continued CPs in patients with MRSA or VRE colonization/infec- tion. Patients with draining wounds or uncontained respiratory secretions remained on CPs regardless of organism. Trained infec- tion preventionistsmonitored CLABSIs, as defined by theNational Healthcare Safety Network (NHSN), in the PPCU, PICU, NICU, and ACP. Since 2008, our institution implemented multiple differ- ent infection prevention interventions as part of a bundled hori- zontal infection control platform. These interventions included (1) hand hygiene (HH) monitoring in 2008, (2) implementation of central-line checklists in 2008, (3) a bare-below the elbows (BBE) approach to HCP attire in 2009, (4) CP monitoring in 2009, and (5) daily chlorohexidine (CHG) bathing in patients ≥2 months of age with central lines and urinary catheters in 2016 (Table 1). We used a 2-proportion Z test to compare CLABSI rates in the 60-month period before and after discontinu- ation of CPs spanning from April 1, 2008, to March 31, 2018. Surveillance of CLABSI in ACP and PPCU did not start until 2010 (39 months before discontinuation of CPs), and our PPCU unit closed in January 2018 (58 months after discontinuation of CPs). We used the Student t test to assess the difference in antimi- crobial consumption before and after discontinuation of CPs. All statistical tests were performed using JMP Pro 13 software (SAS Institute, Inc, Cary, NC). P < .05 was considered statistically significant.


Results


There was no difference in the rates of MRSA and VRE CLABSI before and after discontinuation of CPs in ACP, PPCU, PICU,


, Barry J. Rittmann MD2, Michele Fleming MSN, RN, CIC2, Heather Albert BSN, RN, CIC2, Yvette Major MBA, MT(ASCP)2, HuongJane Nguyen2, Andrew J.Noda PharmD3, Kaila Cooper MSN,RN2, Michelle Doll MD,


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