Stopping contact precautions did not impact nosocomial MRSA or VRE, study finds
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Stopping contact precautions for MRSA and vancomycin-resistant enterococci did not lead to a major increase in either infection at five Texas hospitals, researchers reported at the SHEA Spring Conference.
Their study assessed the impact of isolation protocols on the rate of nosocomial MRSA and vancomycin-resistant enterococci (VRE) infections over the course of more than 1 1/2 years.
“This study adds to existing evidence in the literature and CDC recommendations for a [personal protective equipment (PPE)] crisis that discontinuation of contact isolation might be appropriate, and this can be particularly helpful during PPE shortage as we have seen in the pandemic,” Marisa Hudson, a medical student at Baylor College of Medicine, and Mayar Al Mohajer, MD, medical director of infection prevention, diagnostic stewardship and antimicrobial stewardship at Baylor St. Luke’s Medical Center and Catholic Health Initiatives Texas Division, told Healio.
Hudson and Mohajer retrospectively reviewed the charts of 2,200 adult patients with MRSA or VRE infection at the five hospitals between March 2019 and October 2020. They analyzed data on demographics, infection sites, symptoms and antibiotic use, and reviewed the rate of hospital-acquired MRSA and VRE before and after the discontinuation of isolation protocols.
They found that the rate of MRSA was 12.19 per 10,000 patient days before contact protocols were ended and 10.64 afterward (P = .038). Similarly, the rate of MRSA bacteremia was 1.13 and 0.93 per 10,000 patient days before and after the intervention, respectively (P = .074). The rate of VRE was 3.53 and 4.44 per 10,000 patient days in the pre- and postintervention groups, respectively (P = .274).
A separate analysis published in JAMA Network Open recently showed that contact precautions in Veterans Affairs hospitals reduced MRSA transmission by 50%. Hudson and Mohajer said the results differed because the study designs were different and looked for different outcomes. The JAMA study assessed transmissibility whereas the current study assessed whether there was an increase in infections after discontinuing contact precautions, they said.
“Our findings support other studies that discontinuation of contact precautions does not lead to an increase in hospital-acquired infections. This is very helpful during PPE shortage,” they said. “Other studies have also shown a potential negative impact of contact precautions — less time with the patient and more patient anxiety or depression.”
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Hudson M, Al Mohajer M. Discontinuation of contact precautions in patients with nosocomial MRSA and VRE infections during the COVID-19 pandemic. Presented at: SHEA Spring Conference; April 13-16, 2021 (virtual meeting).
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