Can we reduce contact precautions days for methicillin-resistant Staphylococcus aureus and vancomycin resistant Enterococcus infected patients?

Abstract

BackgroundPatients with MRSA (methicillin-resistant Staphylococcus aureus) and VRE (vancomycin resistant Enterococcus) are placed under contact precautions according to the Center of Disease Control protocol. Contact precautions however increases patient isolation from Health Care Workers, increase overall hospital costs and may increase depression and anxiety. Our aim in this study was to observe the effects of shortening the number of days of contact precautions for patients infected with MRSA and VRE. MethodWe observed patients as two cohorts (Pre-Pilot and Pilot) in one Medical Intensive Care Unit, one Surgical Intensive Care Unit & two medical floors during 2014–2015. In the Pre-pilot period contact precautions were kept throughout admission. In the Pilot period contact precautions were initially placed followed by universal gloving. Comparisons were made for MRSA and VRE infection rates. Total costs were estimated assuming the average cost of 1 gown was $26 per patient per day. ResultsMean isolation days were reduced from 11.9 days to 6.8 days for MRSA and 12.8 days to 8.4 days for VRE. There were 86 MRSA infections in the Pre-Pilot period and 73 MRSA infections during the Pilot period (p=0.052). Incidence of hospital acquired MRSA in the wards decreased from 15 to 7 cases and 6 to 2 cases in the Intensive Care Unit in both the Pilot and Pre-Pilot periods respectively. Cost reduced by $2476 and $17,336 per month for VRE and MRSA patients. Number of readmissions also decreased by 39% for MRSA and 50% for VRE. ConclusionsA reduction in contact precautions has reduced patient costs without affecting the rate of MRSA and VRE infection within a one-year period.