Transmission-based contact precautions for multidrug-resistant organisms in trauma patients: fewer days in isolation with no increase in hospital-associated infections.

Abstract

Our hospital transitioned from routine to selective contact isolation of patients based not on history or diagnosis of multidrug-resistant organisms (MDROs) but rather on the likelihood the patient was soiling their environment. We hypothesized that the change to true transmission-based contact isolation would not be associated with an increase in hospital-associated infections with MDROs. We performed a retrospective study of trauma admissions during two periods: the first period (March to August 2011, PRE group) before and the second period (March to August 2012, POST group) after implementation of the new transmission-based contact isolation guidelines. We compared the PRE and POST groups for admission demographics and physiology as well as mechanism and severity of injury. The primary outcome was the number of patients placed in contact isolation. There were 1,465 and 1,617 trauma admissions during the PRE and POST periods, respectively. The PRE and POST groups were similar for age, sex, admission physiology, mechanism of injury, and injury severity. Overall, 3.3% (n = 49) of the patients in the PRE group were placed in contact isolation as compared with 1.7% (n = 25) in the POST group (p = 0.001). More than double the number of patient days were spent in isolation in the PRE period than the POST period (3.8% [n = 246 days] vs. 1.7% [n = 131 days], p < 0.001). There was no difference between the PRE and POST groups in the rates of developing hospital-acquired MDRO infections (0.2% [n = 3] vs. 0.2% [n = 4], p = 0.99). Transitioning from routine MDRO contact precautions to transmission-based MDRO contact precautions can reduce the number of trauma patients requiring isolation without an increase in hospital-acquired MDRO infections. Therapeutic/care management, level IV.