Infection Control & Hospital Epidemiology
The study has several limitations. We used a quasi-experimental design and single-center data. Data on compliance for BBE, CHG bathing, and central-line checklists throughout the study period were incomplete. Generalizability to larger children’s hos- pitals may be limited due to CHoR’s small size and integration into an adult facility. The total antibiotic consumption was significantly higher before the discontinuation of CPs. Antibiotic consumption data were only available for 8months before the change in CP strat- egy, thereby limiting the comparison between the 2 periods. The potential impact of greater antibiotic use is unknown and may have presumably decreased the overall rate of infection or increased multidrug-resistant organism selective pressure during standard CP practice. Furthermore, longitudinal data were not available on MRSA or VRE colonization burden, although active surveillance for MRSA in the NICU was previously performed from 2007 to 2015. Discontinuation of MRSA surveillance occurred in February 2015 due to a sustained MRSA colonization rate of <
1%.Inanadult cluster-randomized trial, active MRSA andVRE detection and isola- tion did not control endemic infection.8 Additionally, an adult study discontinued CPs and found no increase inMRSA orVRE coloniza- tion/infection with active surveillance methods in place.9 In conclusion, we discontinued CPs for infected or colonized
pediatric patients with MRSA or VRE and did not observe an increase in CLABSI rates at our institution. Discontinuation of MRSA and VRE CPs in the setting of a bundled horizontal infec- tion prevention platform may be an alternative for the control of endemic pathogens. Further studies are needed to define optimal infection prevention strategies to control MRSA and VRE in pediatric populations.
Author ORCIDs. Emily J. Godbout, 0000-0001-6732-7751
475 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. MD and GB have received grant support from Molnlycke Health Care.
References 1. Harris AD, Pineles L, Belton B, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA 2013;310:1571–1580.
2. Catalano G, Houston SH, Catalano MC, et al. Anxiety and depression in hospitalized patients in resistant organism isolation. South Med J 2003;96: 141–145.
3. Day HR, Morgan DJ, Himelhoch S, Young A, Perencevich EN. Association between depression and contact precautions in veterans at hospital admis- sion. Am J Infect Control 2011;39:163–165.
4. Stelfox HT, Bates DW, Redelmeier DA. Safety of patients isolated for infec- tion control. JAMA 2003;290:1899–1905.
5. Edmond MB, Masroor N, Stevens MP, Ober J, Bearman G. The impact of discontinuing contact precautions for VRE and MRSA on device-associated infections. Infect Control Hosp Epidemiol 2015;36:978–980.
6. Bearman G, Abbas S, Masroor N, et al. Impact of discontinuing contact pre- cautions for methicillin-resistant Staphylococcus aureus and vancomycin- resistant Enterococcus: an interrupted time series analysis. Infect Control Hosp Epidemiol 2018;39:676–682.
7. HAI data and statistics. Centers for Disease Control and Prevention website.
https://www.cdc.gov/hai/surveillance/. Published 2016. Accessed May 16, 2018.
8. Huskins WC, Huckabee CM, O’Grady NP, et al. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 2011; 364:1407–1418.
9. Gandra S, Barysauskas CM, Mack DA, Barton B, Finberg R, Ellison RT. Impact of contact precautions on falls, pressure ulcers and transmission of MRSA and VRE in hospitalized patients. J Hosp Infect 2014;88:170–176.
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