Ending contact precautions does not affect CLABSI rate in children

The discontinuation of contact precautions aimed at reducing MRSA and vancomycin-resistant Enterococcus in a children’s hospital did not change the rate of central line-associated bloodstream infections, or CLABSIs, according to research published in Infection Control & Hospital Epidemiology.

Emily J. Godbout, DO, MPH, assistant professor and director of pediatric antimicrobial stewardship at the Children’s Hospital of Richmond, and colleagues noted that data regarding the efficacy of contact precautions on hospital-acquired infections in pediatric settings are limited, but previous studies have shown that adults placed on contact precautions have fewer visits from health care personnel, as well as increased rates of anxiety, depression and dissatisfaction.

A separate study published in Infection Control & Hospital Epidemiology also found that removing routine contact precautions reduced noninfectious adverse events among hospitalized patients with MRSA and vancomycin-resistant Enterococcus (VRE) who did not require isolation.

Godbout and colleagues examined the effects of discontinuing contact precautions for pediatric patients with MRSA or VRE in a quasi-experimental, before-and-after study that was conducted at the Children’s Hospital of Richmond, a 103-bed academic children’s hospital. The researchers explained that contact precautions were just one intervention in a “bundled horizontal infection control platform” at their hospital. Other interventions included hand hygiene monitoring, implementation of central line checklists, bare-elbow attire for health care workers, and daily chlorohexidine bathing in patients aged older than 2 months who had central lines and urinary catheters.

Godbout and colleagues assessed the rates of CLABSIs 60 months before and after the discontinuation of contact precautions in April 2013.

The researchers observed no changes in the rate of MRSA and VRE CLABSIs after discontinuing contact precautions in acute-care pediatrics (ACP), the pediatric progressive care unit (PPCU), the PICU, the NICU and all other settings combined. Additionally, they observed no change in CLABSI rates due to all pathogens — including MRSA and VRE — in the PPCU or the PICU.

After discontinuing contact precautions, the researchers observed a statistically significant decrease in CLABSIs caused by all pathogens in ACP, the NICU and in all settings combined.

Notably, the researchers said, hand hygiene compliance exceeded 90% in the 60 months before and after contact precautions were discontinued.

Additionally, average total antibiotic consumption decreased from 567 days of therapy (DOT) per 1,000 patient-days to 500 DOT per 1,000 patient-days (P = .0164) before and after discontinuation of contact precautions.

“Discontinuation of MRSA and VRE contact precautions in the setting of a bundled horizontal infection prevention platform may be an alternative for the control of endemic pathogens,” Godbout and colleagues wrote. “Further studies are needed to define optimal infection prevention strategies to control MRSA and VRE in pediatric populations.” – by Katherine Bortz

References:

Godbout EJ, et al. Infect Control Hosp Epidemiol. 2019;doi:10.1017/ice.2019.19.

Martin EM, et al. Infect Control Hosp Epidemiol. 2018;doi:10.1017/ice.2018.93.

Disclosures: The authors report no relevant financial disclosures.