Hospitals that kept control measures in place saw less MRSA during pandemic
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Key takeaways:
- Fewer MRSA health care-associated infections were reported when facilities practiced active surveillance and contact precautions.
- The impact of these precautions was greater in ICUs compared with non-ICUs.
SEATTLE — Veterans Affairs facilities that opted not to suspend active surveillance and contact precautions during the COVID-19 pandemic reported fewer health care-associated MRSA infections, especially in ICUs, researchers found.
“Back in 2007, we created what was the Veterans Health Administration MRSA prevention initiative. There was a need at that time to reduce MRSA health care-associated infections (HAIs) across all 130 acute-care facilities, as well as long-term care facilities,” Brian McCauley, DPM, MHSA, national Veterans Affairs multidrug-resistant organisms program manager, said during a presentation at the Society for Healthcare Epidemiology of America Spring Conference.
“We get to 2020 and the COVID-19 pandemic and there were implications for the MRSA program,” McCauley said. “For active surveillance screening, many facilities in the country were using PCR and that was now going to have to be used for identification of COVID-19.”
Because of limited resources, the VA instituted a policy that allowed facilities to discontinue active surveillance, suspend contact precautions for patients colonized or infected with MRSA, and reduce the use of personal protective equipment (PPE).
McCauley assessed the impact of suspending three of these precautions — active surveillance (AS) and contact precautions for patients colonized (CPC) or infected (CPI) with MRSA — in a prospective cohort study from July 2020 through June 2022 at 123 acute-care VA medical facilities, which had the option to suspend any combination of AS, CPC or CPI to clear laboratory resources for COVID-19 testing and conserve PPE.
The primary endpoint of the study was the rate of MRSA HAIs per 1,000 patient-days in ICUs and non-ICUs.
During the study period, there were 917,591 admissions accounting for 5,225,174 patient-days, and 568 reported MRSA HAIs. According to the study, the MRSA HAI rate for all infection sites in non-ICUs was 0.07 (95% CI, 0.05-0.08) per 1,000 patient days for facilities practicing AS, CPC and CPI, compared with 0.12 (95% CI, 0.08-0.19) for those not practicing any of these strategies. The infection rates in ICUs were 0.2 (95% CI, 0.15-0.26) and 0.65 (95% CI, 0.41-0.98) for the respective policies. These rates were also similar when the researchers restricted the analyses to MRSA bloodstream HAIs.
McCauley said that even after accounting for monthly COVID-19 admissions, the relationship between facility policy and MRSA HAI rates in ICUs or non-ICUs did not change.
“MRSA HAI rates increased as the number of interventions decreased,” McCauley said. “Differences in rates between ICUs and non-ICUs may be a consideration for policy decisions.”
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McCauley B, et al. Active surveillance and contact precautions for preventing MRSA healthcare-associated infections during COVID-19 pandemic. Presented at: Society for Healthcare Epidemiology of America Spring Meeting; April 11-14, 2023; Seattle.
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