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Hospital adverse events decline after routine contact precautions removed
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One year after discontinuing routine contact precautions, researchers observed a significant reduction in noninfectious adverse events among hospitalized patients, particularly those with MRSA and vancomycin-resistant Enterococcus who no longer required isolation.
The findings build on a previous study conducted at the same hospital, which showed that the removal of contact precautions (CPs) for endemic MRSA and vancomycin-resistant Enterococcus (VRE) did not increase the prevalence of either pathogen and saved the hospital an estimated $643,776 on materials each year, Elise M. Martin, MD, MS, assistant clinical professor of medicine in the division of infectious diseases at the University of California, Los Angeles’ David Geffen School of Medicine, and colleagues reported in Infection Control & Hospital Epidemiology.
According to the researchers, CP use has been linked to shorter and fewer health care provider visits, as well as anxiety, depression and lower satisfaction among patients. In addition, multiple studies have shown an increase in preventable adverse events with CPs, including falls, pressure ulcers, medication administrations errors and deep vein thrombosis.
To further investigate the association, Martin and colleagues compared the rates of hospital adverse events 1 year before and 1 year after routine CP use was terminated at the Ronald Reagan UCLA Medical Center in 2014. During the preintervention period before CP elimination, daily chlorhexidine gluconate bathing was required for nearly all patients, except neonates and perinatal patients. During the postintervention period, routine CP use was discontinued in all patients, including those with infection, colonization and a prior history of MRSA, VRE or both.
Over the course of the study, the rate of noninfectious adverse events — such as falls and trauma; postoperative hemorrhage; postoperative respiratory failure; wound dehiscence; pressure ulcer; and pulmonary embolism — decreased 19%, from 12.3 per 1,000 admissions during the preintervention period to 10 per 1,000 admissions during the postintervention period. The largest reduction occurred among patients with MRSA, VRE or both, with the rate of noninfectious adverse events declining 72%, from 21.4 per 1,000 admissions to 6.08 per 1,000 admissions. Meanwhile, there was no significant difference in the incidence of infectious adverse events, including hospital-onset Clostridium difficile infection, catheter-associated urinary tract infection, central-line-associated bloodstream infection, postoperative sepsis, surgical site infection and ventilator-associated pneumonia. These events occurred among 20.7 per 1,000 admissions during the preintervention period and 19.4 per 1,000 admissions during the postintervention period.
“These data support prior research indicating that the use of CP can be a barrier to health care providers and that this can impact adverse event rates,” the researchers concluded. “More data on the optimal hospital conditions and quality environment programs are needed to make this intervention successful. Given that CP are likely still necessary for specific populations, strategies to increase contact with health care providers and decrease noninfectious adverse events in these patients should be developed.” – by Stephanie Viguers
Disclosures: The authors report no relevant financial disclosures.
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