570. Impact of Discontinuation of Methicillin-Resistant Staphylococcus aureus Contact Precautions on Bloodstream Infection Rates at an Academic Medical Center

Abstract

BackgroundContact precautions (CP) in methicillin-resistant Staphylococcus aureus (MRSA) patients along with hand hygiene has been considered a gold standard to prevent transmission. The actual impact of these measures in reducing MRSA infections is still controversial. At our institution, we evaluated the impact of discontinuation of MRSA CP on hospital-onset (HO) and community-onset (CO) MRSA bloodstream (BSI) rates. We also analyzed consequential cost savings.MethodsThe University of Mississippi Medical Center is a 700+ bed academic facility located in Jackson, MS. Patients admitted to any inpatient units with diagnoses or history of MRSA infection or colonization were subjected to CP during their stay. In July 2018, we discontinued MRSA CP across all inpatient units (except neonatal intensive care unit). HO MRSA BSI rate was calculated per National Healthcare Safety Network (NHSN) laboratory-identified event. CO MRSA BSI was reported per NHSN admission prevalence rate. One-way Analysis of Variance (ANOVA) was performed to compare pre-and post-intervention data.ResultsThere was a rise in HO MRSA BSI rate after discontinuation of CP (July 2018-March 2019) in comparison to the 9-month pre-intervention period (October 2017-June 2018); however, the difference was not statistically significant (1.79/10,000 patient-days vs. 1.2/10,000 patient-days; P = 0.056). Similarly, CO MRSA BSI prevalence rate did not show a statistically significant difference between pre- and post-intervention period (0.103 vs. 0.08; P = 0.584).The total annualized cost savings on personal protective equipment (PPE) was an estimated $193,398 post-intervention. Hand hygiene (HH) compliance was higher in post-intervention compared with pre-intervention period (83% vs. 78%, P = 0.0007).ConclusionAt our institute, discontinuation of MRSA CP was associated with an insignificant rise in HO MRSA BSI rates. No impact was observed on CO MRSA BSI prevalence. We had a 34% reduction in PPE expenditure. We observed an increase in HH compliance post-discontinuation of CP, but it did not reduce MRSA BSI rates. Further studies are needed to evaluate the impact of bundling hand hygiene practices with other horizontal strategies (prevention bundles, chlorhexidine bathing, environmental disinfection practices) in prevention of MRSA infections. Disclosures All authors: No reported disclosures.