Discontinuation Of Contact Precautions Research Articles

Impact of discontinuation of contact precautions on surveillance- and whole genome sequencing-defined methicillin-resistant Staphylococcus aureus healthcare-associated infections.

Prior studies evaluating the impact of discontinuation of contact precautions (DcCP) on methicillin-resistant Staphylococcus aureus (MRSA) outcomes have characterized all healthcare-associated infections (HAIs) rather than those likely preventable by contact precautions. We aimed to analyze the impact of DcCP on the rate of MRSA HAI including transmission events identified through whole genome sequencing (WGS) surveillance. Quasi experimental interrupted time series. Acute care medical center. Inpatients. The effect of DcCP (use of gowns and gloves) for encounters among patients with MRSA carriage was evaluated using time series analysis of MRSA HAI rates from January 2019 through December 2022, compared to WGS-defined attributable transmission events before and after DcCP in December 2020. The MRSA HAI rate was 4.22/10,000 patient days before and 2.98/10,000 patient days after DcCP (incidence rate ratio [IRR] 0.71 [95% confidence interval 0.56-0.89]) with a significant immediate decrease (P = .001). There were 7 WGS-defined attributable transmission events before and 11 events after DcCP (incident rate ratio 0.90 [95% confidence interval 0.30-2.55]). DcCP did not result in an increase in MRSA HAI or, in WGS-defined attributable transmission events. Comprehensive analyses of the effect of transmission prevention measures should include outcomes specifically measuring transmission-associated HAI.

Discontinuation of contact precautions in patients with hospital-acquired MRSA and VRE infections during the COVID-19 pandemic: A multi-center experience.

Variations in the literature support the benefit of contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) infections in the hospital setting. During personal protective equipment shortages throughout the COVID-19 pandemic, contact precautions were discontinued for MRSA and VRE-infected patients. Rates of hospital-acquired MRSA and VRE infections were compared before and after this intervention, along with hand hygiene proportions. Contact precaution discontinuation did not lead to an increase in hospital-acquired MRSA or VRE infections.

Impact of discontinuation of contact precautions on surveillance- and whole-genome sequencing-defined MRSA infections

Background: Current guidelines recommend contact precautions to prevent transmission of methicillin-resistant Staphylococcus aureus (MRSA) in acute-care hospitals. Prior literature demonstrates that discontinuation of contact precautions for MRSA has not been associated with an increase in carriage rates including surveillance-defined healthcare-associated infection (HAI) while horizontal infection prevention strategies are implemented. Objective: To analyze the impact of discontinuation of contact precautions on the rate of MRSA infections, including surveillance-defined HAI and transmission events identified through whole-genome sequencing (WGS) surveillance. Methods: In this single tertiary-care center, retrospective, observational, quality improvement analysis, we measured 2 MRSA HAI outcomes before and after discontinuation of contact precautions (ie, gown and gloves no longer required for care of patients with prior or current MRSA infections or colonization, effective December 2, 2020). First, we conducted a time-series analysis using linear regression modelling of NHSN reported MRSA HAI rates (January 2019–November 2022). We also calculated the frequency of WGS-confirmed MRSA transmission events before in the discontinuation of contact precautions (January 2019–August 2019) and after the discontinuation of contact precautions (January 2022–November 2022) periods. Surveillance HAI events were determined using NHSN definitions; MRSA transmission events were defined as an isolate identified ≥3 days after hospitalization or within 30 days of a healthcare exposure, genetically related by ≤15 single-nucleotide polymorphisms compared to ≥1 previously sequenced MRSA isolate. Results: We identified 171 MRSA HAIs in the 23 months before discontinuation of contact precautions, corresponding to 4.24 HAI per 10,000 patient days, and 129 HAIs in the 24 months after discontinuation of contact precautions, corresponding to 3.01 HAI per 10,000 patient days (Fig.). We detected a nonsignificant change in the trend in HAI rate before and after discontinuation of contact precautions (P = .22) as well as a significant immediate decrease in the MRSA HAI rate (P < 0 .001) at the time of discontinuation of contact precautions. In the WGS analysis 8 months before discontinuation of contact precautions, 11 MRSA transmission events were confirmed, comprising 4 clusters (0.75 per 10,000 patient days). In the WGS for the 11-month analysis period after discontinuation of contact precautions, there were 23 confirmed MRSA transmission events comprising 10 clusters (1.22 per 10,000 patient days; incidence rate ratio, 1.61; 95% CI, 0.75–3.66; P = .19). Conclusions: After discontinuation of contact precautions, there was no significant increase in MRSA HAI or transmission events. Further evaluation of the individual WGS transmission clusters will be helpful to determine whether discontinuation of contact precautions led to MRSA transmission in this facility in the period after discontinuation of contact precautions.Disclosure: None

Discontinuing MRSA and VRE contact precautions: Defining hospital characteristics and infection prevention practices predicting safe de-escalation.

To define conditions in which contact precautions can be safely discontinued for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Interrupted time series. 15 acute-care hospitals. Inpatients. Contact precautions for endemic MRSA and VRE were discontinued in 12 intervention hospitals and continued at 3 nonintervention hospitals. Rates of MRSA and VRE healthcare-associated infections (HAIs) were collected for 12 months before and after. Trends in HAI rates were analyzed using Poisson regression. To predict conditions when contact precautions may be safely discontinued, selected baseline hospital characteristics and infection prevention practices were correlated with HAI rate changes, stratified by hospital. Aggregated HAI rates from intervention hospitals before and after discontinuation of contact precautions were 0.14 and 0.15 MRSA HAI per 1,000 patient days (P = .74), 0.05 and 0.05 VRE HAI per 1,000 patient days (P = .96), and 0.04 and 0.04 MRSA laboratory-identified (LabID) events per 100 admissions (P = .57). No statistically significant rate changes occurred between intervention and non-intervention hospitals. All successful hospitals had low baseline MRSA and VRE HAI rates and high hand hygiene adherence. We observed no correlations between rate changes after discontinuation and the assessed hospital characteristics and infection prevention factors, but the rate improved with higher proportion of semiprivate rooms (P = .04). Discontinuing contact precautions for MRSA/VRE did not result in increased HAI rates, suggesting that contact precautions can be safely removed from diverse hospitals, including community hospitals and those with lower proportions of private rooms. Good hand hygiene and low baseline HAI rates may be conditions permissive of safe removal of contact precautions.

Impact of discontinuing contact precautions and enforcement of basic hygiene measures on nosocomial vancomycin-resistant Enterococcus faecium transmission

Vancomycin-resistant Enterococcus faecium (VREfm) has emerged as a pathogen of major concern for public health. Although definitive evidence is lacking, contact precautions have been a crucial element in infection prevention and control (IPC) strategies designed to limit nosocomial VRE transmission. This study investigated the effect of discontinuing contact precautions while enforcing basic hygiene measures, including hand hygiene, environmental cleaning and antiseptic body washing, for patients with VRE in intensive care units (ICUs) on the prevention of nosocomial VRE transmission causing bacteraemia. Contact precautions were discontinued in January 2018. In total, 96 VREfm isolates from 61 patients with VREfm bacteraemia and/or colonization hospitalized in eight ICUs in a tertiary care hospital in 2016 and 2019 in were characterized by whole-genome sequencing. VRE transmission was investigated using patient movement data and admission screening for reliable identification of nosocomial acquisition. Discontinuation of contact precautions did not increase VREfm transmission events (eight in 2016 vs one in 2019). While the rate of endogenous VREfm was similar in both years (38% vs 31%), the number of non-colonized patients prior to VREfm bacteraemia was 16 (16/29, 55%) in 2019, which was significantly higher than in 2016 (8/32, 25%). The mean incidence density for VREfm bacteraemia was similar for both years (0.26 vs 0.31 per 1000 patient-days in 2016 and 2019, respectively). Discontinuation of contact precautions while enforcing basic hygiene measures did not lead to an increase in nosocomial bloodstream infection rates due to VREfm transmission in a hyperendemic ICU setting.

Discontinuation of Contact Precautions in Patients with Nosocomial MRSA and VRE Infections During the COVID-19 Pandemic

Background: Gaps exist in the evidence supporting the benefits of contact precautions for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). The Centers for Disease Control and Prevention allow suspending contact precautions for MRSA and VRE in cases of gown shortages, as we have seen during the COVID-19 pandemic. We evaluated the impact of discontinuing isolation precautions in hospitalized patients with MRSA and VRE infection, due to gown shortage, on the rate of hospital-acquired (HA) MRSA and VRE infections. Methods: A retrospective chart review was performed on adult patients (n = 2,200) with established MRSA or VRE infection at 5 hospitals in CommonSpirit Health, Texas Division, from March 2019 to October 2020. Data including demographics, infection site, documented symptoms, and antibiotic use were stratified based on patient location (floor vs ICU). Rates of hospital-acquired MRSA and VRE infection before and after the discontinuation of isolation (implemented in March 2020) were compared. Incidence density rate was used to assess differences in the rate of MRSA and VRE infections between pre- and postintervention groups. Results: The rate of hospital-acquired (HA) MRSA infection per 10,000 patient days before the intervention (March 19–February 20) was 12.19, compared to 10.64 after the intervention (March 20–July 20) (P = .038). The rates of HA MRSA bacteremia were 1.13 and 0.93 for the pre- and postintervention groups, respectively (P = .074). The rates of HA VRE per 10,000 patient days were 3.53 and 4.44 for the pre- and postintervention groups, respectively (P = .274). The hand hygiene rates were 0.93 before the intervention and 0.97 after the intervention (P = .028). Conclusions: Discontinuing isolation from MRSA and VRE in the hospital setting did not lead to a statistically significant increase in hospital-acquired MRSA or VRE infections. In fact, rates of hospital-acquired MRSA decreased, likely secondary to improvements in hand hygiene during this period. These results support the implementation of policies for discontinuing contact isolation for hospitalized patients with documented MRSA or VRE infection, particularly during shortages of gowns.Funding: NoDisclosures: None

Does the removal of contact precautions for MRSA and VRE infected patients change health care-associated infection rate?: A systematic review and meta-analysis

Update existing meta-analysis to analyze if discontinuation of contact precautions (CPs) for Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin resistant Enterococcus (VRE) colonization or infection affects hospital-associated MRSA or VRE infection rates. We conducted a systematic review of 17 studies evaluating discontinuation of CPs for MRSA and VRE. Random-effects and fixed-effects models were used to determine the pooled risk ratios (RR) of preincidence hospital-associated infection rate to postincidence rate. Subgroup analysis was used to assess sources of heterogeneity. No significant difference between rates of hospital-associated MRSA infection before and after stopping the CPs was observed (RR, 0.84; 95% confidence internal [CI], 0.71-1.01; P = .06). An inverse association was observed between discontinuation of CPs and rates of hospital-associated VRE infection (RR, 0.82; 95% CI, 0.72-0.94; P = .005). A subgroup analysis of 6 studies that used chlorhexidine, showed no difference between rates of hospital-associated MRSA infection with discontinuation of CPs (RR, 0.83; 95% CI, 0.69-1.00; P = .05). In 5 studies that did not use chlorhexidine, there was no difference between rates of hospital-associated MRSA infection with discontinuation of CPs (RR, 1.02; 95% CI, 0.55-1.88; P= .95). There was no significant difference in rates of hospital-associated MRSA infection before and after removing CPs. Additionally, there were decreased rates of hospital-associated VRE infection following stoppage of CPs.

CHG Skin Application in Non-ICU Patients with Central Venous Catheters: Impact on CLABSI, MRSA Bacteremia, and LabID Rates

Background: Prevention of central-line–associated bloodstream infections (CLABSIs) and methicillin-resistant Staphylococcus aureus (MRSA) infections requires a multifaceted approach including strategies to decrease cutaneous bacterial colonization. Prior studies have shown benefit from chlorhexidine-gluconate (CHG) skin application on CLABSI and MRSA infection rates in intensive care units (ICUs); however, the use of CHG in the non-ICU population has not been well studied. Methods: We performed a quasi-experimental before-and-after study to evaluate the use of daily 2% CHG wipes in non-ICU patients at a 1,000 bed acute-care teaching hospital beginning in November 2017. The study population included adult and pediatric patients with central venous catheters on non-ICU units, excluding patients on the following units: stem cell transplant and hematologic malignancy (these units had already established use of CHG skin application as a standard prior to the intervention), labor and delivery, and psychiatry. CHG was applied according to the manufacturer’s instruction by nurses or nurse aides and random monthly auditing of compliance was performed. NHSN CLABSI, hospital-onset MRSA bacteremia, and hospital-onset MRSA LabID rates were compared for the period 24 months before the intervention (November 1, 2015, through October 31, 2017) to the 24-month period after the intervention (November 1, 2017, through October 31, 2019) using a paired t test. Notably, the health system also discontinued the use of contact precautions for patients with MRSA (excluding MRSA from open, draining wounds) 11 months prior to onset of this intervention. Results: The CLABSI rate decreased by 26% from 0.594 events per 1,000 central-line days (n = 50) before the intervention to 0.438 events per 1,000 central-line days (n = 38) after the intervention (P = 0.19). The number of CLABSIs with gram-positive organisms also decreased by 29%. MRSA LabID rates decreased by 37% from 0.301 events per 1,000 patient days (n = 119) to 0.189 events per 1,000 patient days (n = 75) (P = 0.01). MRSA bacteremia rates decreased by 79% from 0.058 events per 1,000 patient days (n = 23) to 0.012 events per 1,000 patient days (n = 5) (P < 0.01). Compliance with the intervention was 83% (n = 225). Conclusions: Daily CHG skin application in non-ICU patients with central venous catheters is an effective strategy to prevent CLABSIs and MRSA infections. We observed a decrease in MRSA LabID and bacteremia rates despite discontinuation of contact precautions. These findings suggest that a horizontal prevention approach of daily CHG skin application may be an effective alternative to contact isolation to interrupt transmission of MRSA in hospitalized patients outside the ICU setting.Funding: NoneDisclosures: None

527. Project “Isolation Zero”: Discontinuing Contact Precautions for Patients Colonized/Infected with Multidrug-Resistant Organisms through Community-Level Follow-Up in Spain

BackgroundIn an effort to prevent and control the spread of multidrug-resistant organisms (MDROs), hospitals implement contact precautions (CP) for patients colonized/infected with MDROs. All agencies related to the prevention and control of infections recommend this practice, but they also recognize that is not exempt from unintended consequences. In 2017, SHEA published an expert guideline where they provide recommendations for discontinuation of CP. Currently, the most accepted recommendation is to perform at least one microbiological culture prior to discontinuing CP. The main objective of this project is to implement and evaluate a novel community -level approach to safely discontinue CP in patients with a history of colonization/infection with an MDRO.MethodsThe “Isolation Zero” project (IZ) was rolled out in November 2018 in the healthcare area of A Coruña, Spain. All clinical records of patients included in the MDROs alert system between 2005–2012 in A Coruña were reviewed. Patients included in the study were those who reside in the healthcare area of A Coruña and did not have any positive microbiological culture for MDROs in the last 2 years (Figure 1). Those who met the inclusion criteria were sent a letter suggesting that they obtain a nurse consultation in the next 2 months and that they provide specific MDRO cultures (Figure 2). Finally, the Department of Preventive Medicine (PM) reviewed all the results and identified patients for which CP could be safely discontinued in future hospitalizations.ResultsA total of 792 clinical records were reviewed (Table 1). 184 patients met the inclusion criteria. The response rate was 60.3% (111 patients). The most frequent MDRO tested was MRSA (84.8%), followed by MDR Acinetobacter (7.6%). CP were withdrawn for a total of 83 patients, while 15 patients continued to test positive (Table 2).ConclusionThese results suggest that even after more than 2 years without a positive result, 13,5% of patients remain positive for MDROs. Therefore, in order to safely minimize the use of CP, we conclude that an approach similar to that used in IZ is a good option for PM Departments. Follow-up at the community -level can help reduce the number of hospital isolations required and can help improve the overall quality of care. Disclosures All authors: No reported disclosures.

Risk Factors for Long-Term Vancomycin-Resistant Enterococci Persistence-A Prospective Longitudinal Study.

Vancomycin-resistant enterococci (VRE) are important nosocomial pathogens that require effective infection control measures, representing a challenge for healthcare systems. This study aimed at identifying risk factors associated with prolonged VRE carriage and determining the rate of clearance that allows the discontinuation of contact precautions. During a 2-year study, screening was performed in patients with a history of VRE or at risk of becoming colonized. After bacterial identification and antibiotic susceptibility testing, glycopeptide resistance was confirmed by PCR. Isolates were compared via whole genome sequence-based typing. Risk factors were recorded, and follow-up screening was performed upon readmission, defining patients as long-term carriers if still colonized ≥10 weeks after first detection. Of 1059 patients positive for VRE, carriage status was assessed upon readmission in 463 patients. VRE was cleared in 56.4% of the cases. Risk factors associated with long-term persistence were hospital stays (frequency, length), hemato-oncological disease, systemic treatment with steroids, and use of antibiotics. No specific genotypic clustering was observed in patients with VRE clearance or persistence. VRE clearance is possibly underestimated. The identification of risk factors favoring long-term carriage may contribute to a targeted implementation of infection control measures upon readmission of patients with history of VRE.

Incidence of health care–associated extended-spectrum β-lactamase-positive patients before and after discontinuation of contact precautions

Isolation of patients with multidrug-resistant organisms has been recommended in several guidelines. Recent evidence has suggested potential negative effects of isolation on patient well-being and facility throughput. Published literature shows a difference in transmission risk of extended-spectrum β-lactamase (ESBL)-producing organisms, suggesting that contact precautions may not be necessary for all ESBL-positive organisms. Incidence rates of health care-associated ESBL organisms were measured before and after eliminating the use of contact precautions for patients with only ESBL-positive organisms. The National Healthcare Safety Network surveillance methodology was used to measure incidence. Surgical site infections and carbapenem-resistant Enterobacteriaceae were excluded from the surveillance incidence. The incidence of health care-associated ESBL infections from January 2014 through November 2015 was 3.71 per 10,000 patient days. The incidence from December 2015 through August 2017 was 3.00 per 10,000 patient days. This rate change was statistically significant (P = .022) CONCLUSIONS: This study found that discontinuing the use of contact precautions for patients colonized or infected with ESBL-positive organisms did not lead to an increased rate of health care-associated ESBL-positive infections or colonization.

The discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: Impact upon patient adverse events and hospital operations

BackgroundContact precautions for endemic methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) are a resource-intensive intervention to reduce healthcare-associated infections, potentially impeding patient throughput and limiting bed availability to isolate...

Impact of discontinuing contact precautions against vancomycin resistant Enterococcus: Multicenter study in Argentina

Background: Contact precautions (CP) are widely recommended to prevent multidrug-resistant organism (MDRO) transmission avoiding colonization and infection. However, conflicting data exist regarding their effectiveness. Recent studies suggest that for endemic methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant Enterococcus (VRE), standard measures and decolonization for MRSA could be effective. In Argentina there is no formal recommendation, however, most centers implement CP and only a few discontinue them. Our purpose is to evaluate the impact on the EVR infections after discontinuing CP in centers located in Buenos Aires. Methods & Materials: Multicenter, retrospective, quasi-experimental study of patients admitted to acute care facilities in Buenos Aires. We included centers that perform health care associated infections surveillance according to NHSN definitions and discontinued CP for more than 1 year. The CP included the use of gloves, gowns, personnel items or their subsequent disinfection and individual or cohort rooms. EVR infection was defined as the presence of signs and symptoms associated with EVR isolation in clinical samples 48 hours after admission. We compared the number of cases of VRE infections/1000 discharges 1 year before and after discontinuing CP. P 0 .05 was considered statistically significant. During the study, CP were continued for other MDRO (MRSA, multidrug resistant gram-negative bacilli and Clostridium difficile) in addition with the hand hygiene program. Results: Five institutions were included (4 tertiary acute care University Private - 1 Public), 4 polyvalent. Total beds 1308, only 2 centers have shared rooms. One institution reported UCI data. In the preintervention period occurred 27 infections / 61099 discharges (rate 0.44 / 1000 discharges), after CP discontinuation there were 32 infections / 61668 discharges (rate 0.52 / 1000 discharges) (p0.62). The average adherence to hand hygiene in the initial period was 58% and post-intervention 66%. Conclusion: This experience, in different centers, shows that discontinuation of CP was not associated with a significant increase of VRE infections and should be accompanied by cross-sectional measures such as Hand Hygiene. The prevalence of different MDRO infections should be considered to evaluate the cost effectiveness of CP.

Discontinuing contact precautions for multidrug-resistant organisms: A systematic literature review and meta-analysis

Several single-center studies have suggested that eliminating contact precautions (CPs) for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) control in nonoutbreak settings has no impact on infection rates. We performed a systematic literature review and meta-analysis on the impact of discontinuing contact precautions in the acute care setting. We searched PubMed, CINAHL, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and Embase through December 2016 for studies evaluating discontinuation of contact precautions for multidrug-resistant organisms. We used random-effect models to obtain pooled risk ratio estimates. Heterogeneity was evaluated with I2 estimation and the Cochran Q statistic. Pooled risk ratios for MRSA and VRE were assessed separately. Fourteen studies met inclusion criteria and were included in the final review. Six studies discontinued CPs for both MRSA and VRE, 3 for MRSA only, 2 for VRE only, 2 for extended-spectrum β-lactamase-producing Escherichia coli, and 1 for Clostridium difficile infection. When study results were pooled, there was a trend toward reduction of MRSA infection after discontinuing CPs (pooled risk ratio, 0.84; 95% confidence interval, 0.70-1.02; P = .07) and a statistically significant reduction in VRE infection (pooled risk ratio, 0.82; 95% confidence interval, 0.72-0.94; P = .005). Discontinuation of CPs for MRSA and VRE has not been associated with increased infection rates.

Evaluation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus

There are limited controlled data demonstrating contact precautions (CPs) prevent methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) infections in endemic settings. We evaluated changes in hospital-acquired MRSA and VRE infections after discontinuing CPs for these organisms. This is a retrospective study done at an 800-bed teaching hospital in urban Detroit. CPs for MRSA and VRE were discontinued hospital-wide in 2013. Data on MRSA and VRE catheter-associated urinary tract infections (CAUTIs), ventilator-associated pneumonia (VAP), central line-associated bloodstream infections (CLABSIs), surgical site infections (SSIs), and hospital-acquired MRSA bacteremia (HA-MRSAB) rates were compared before and after CPs discontinuation. There were 36,907 and 40,439 patients hospitalized during the two 12-month periods: CPs and no CPs. Infection rates in the CPs and no-CPs periods were as follows: (1) MRSA infections: VAP, 0.13 versus 0.11 (P = .84); CLABSI, 0.11 versus 0.19 (P = .45); SSI, 0 versus 0.14 (P = .50); and CAUTI, 0.025 versus 0.033 (P = .84); (2) VRE infections: CAUTI, 0.27 versus 0.13 (P = .19) and CLABSI, 0.29 versus 0.3 (P = .94); and (3) HA-MRSAB rates: 0.14 versus 0.11 (P = .55), respectively. Discontinuation of CPs did not adversely impact endemic MRSA and VRE infection rates.

Suspending Use of Contact Precautions in Patients Colonized with Methicillin-Resistant Staphylococcus aureus in a Level III Neonatal ICU and Its Effects on Rates of Transmission

BackgroundThere is limited evidence to support whether contact precautions (CP) for MRSA-colonized patients in a Neonatal ICU (NICU) reduces rates of transmission, given current endemic MRSA. This study assesses rates of hospital-associated MRSA (HA-MRSA) in the NICU before and after discontinuation of CP for patients colonized with MRSA.MethodsActive screening for MRSA colonization occurs on admission and weekly for all NICU patients. Clinical infections were identified on routine cultures. Decolonization with Mupirocin and Chlorhexidine bathing was done for all MRSA-positive patients. Rates of HA-MRSA pre, during, and post CP suspension were assessed. MRSA isolates from before and after the contact precautions suspension period were saved and sent for pulse-field gel electrophoresis (PFGE). PFGE results from previous clusters of HA-MRSA isolates were also reviewed. Furthermore, 11 highly-ranked level III NICUs were surveyed to compare infection prevention practices for MRSA isolation. Overt hand hygiene auditing, family education, and enhanced environmental cleaning were in place during the entire study timeframe.ResultsRate of HA-MRSA during 6 month pretrial, 2 month suspension period, and 3 month post-trial was 0.94, 2.24, and 1.05 per 1000 patient-days respectively. During previous outbreaks 14 isolates were sent for PFGE testing resulting in 2 isolates matching. Six isolates from the CP suspension period resulted in 2 matching pairs. Three isolates from post-trial were different from each other and from previous isolates. Survey results revealed 100% of facilities use CP for MRSA-positive patients. Three of 11 NICUs have a decolonization protocol in place, while 10 actively screen for MRSA.ConclusionPreliminary results demonstrated an increase in HA-MRSA after suspending CP for MRSA-colonized patients. According to the survey results, the standard of care appears to be the use of CP for all MRSA-positive patients, although decolonization practices varied. Given the limited size of our study, more data is needed to determine whether CP is necessary to prevent transmission of HA-MRSA in the presence of an active screening and decolonization program, a robust hand hygiene program, and enhanced environmental cleaning in the NICU setting.Disclosures All authors: No reported disclosures.

Routine Use of Contact Precautions for Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus: Which Way Is the Pendulum Swinging?

BACKGROUND Studies have suggested that contact precautions (CP) for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus may have risks that outweigh the benefits. These risks, coupled with more widespread use of horizontal interventions such as daily bathing with chlorhexidine gluconate, have brought into question the value of routine CP for these organisms. OBJECTIVE To assess the state of utilization of CP as well as adjunctive measures to reduce the risk of transmission in US hospitals. DESIGN Cross-sectional survey. PARTICIPANTS Total of 751 physician members of the Emerging Infections Network. METHODS An 8-question electronic survey distributed by email. RESULTS A total of 426/751 (57%) responded to the survey; 337/364 (93%) of respondents use routine CP for methicillin-resistant S. aureus and 335/364 (92%) use routine CP for vancomycin-resistant enterococcus. The most widely used trigger for initiation of CP for both pathogens was positive clinical culture. Practices for discontinuation of isolation varied widely. We found that 325/354 (92%) perform routine chlorhexidine gluconate bathing and 236/353 (67%) perform S. aureus decolonization with mupirocin for 1 or more subsets of inpatients, and 82/356 (23%) reported using either hydrogen peroxide vapor or ultraviolet-C room disinfection at discharge. Free text responses noted frustration and variation in the application, practice, and process for initiation and discontinuation of CP. CONCLUSIONS Use of CP for methicillin-resistant S. aureus and vancomycin-resistant enterococcus remains commonplace, although horizontal interventions such as chlorhexidine gluconate bathing are increasingly used. The heterogeneity of practices and policies was striking. Evidence-based guidelines regarding CP and horizontal interventions are needed. Infect. Control Hosp. Epidemiol. 2015;37(1):36-40.

The Impact of Discontinuing Contact Precautions for VRE and MRSA on Device-Associated Infections.

The impact of discontinuing contact precautions for patients with MRSA and VRE colonization/infection on device-associated hospital-acquired infection rates at an academic medical center was investigated in this before-and-after study. In the setting of a strong horizontal infection prevention platform, discontinuation of contact precautions had no impact on device-associated hospital-acquired infection rates.

Discontinuation of contact precautions for methicillin-resistant staphylococcus aureus: a randomized controlled trial comparing passive and active screening with culture and polymerase chain reaction.

There have been no randomized controlled trials comparing active and passive screening for documenting clearance of colonization with methicillin-resistant Staphylococcus aureus (MRSA). We compared the efficacy of active and passive screening using both culture and commercial polymerase chain reaction (PCR) for documentation of MRSA clearance and discontinuation of MRSA contact precautions (CPs). Inpatients with a history of MRSA infection or colonization enrolled between December 2010 and September 2011 were randomized to either passive (nonintervention arm; n = 202; observation with local standard of care) or active screening (intervention arm; n = 405; study staff screened using culture and commercial PCR). The primary outcome was discontinuation of CPs by trial arm based on 3 negative cultures. In the intervention arm, sensitivity, specificity, and positive and negative predictive values of the first PCR were compared to cultures. CPs were discontinued significantly more often (rate ratio [RR], 4.1; 95% confidence interval [CI], 2.3%-7.1%) in the intervention arm, including in an intent-to-screen analysis (RR, 2.6; 95% CI, 1.5%-4.7%). The first PCR, compared to 3 cultures, detected MRSA with a sensitivity of 93.9% (95% CI, 85.4%-97.6%), a specificity of 92.0% (95% CI, 85.9%-95.6%), a positive predictive value of 86.1% (95% CI, 75.9%-93.1%), and a negative predictive value of 96.6% (95% CI, 91.6%-99.1%). Compared to passive screening using culture methods, active screening resulted in discontinuation of MRSA CPs at a significantly higher frequency. Active screening with a single PCR would significantly increase the completion of the screening process. Clinical Trials Registration. NCT01234831.

Resource Burden Associated with Contact Precautions for Methicillin-ResistantStaphylococcus aureusand Vancomycin-Resistant Enterococcus: The Patient Access Managers' Perspective

We surveyed patient access managers on the impact of contact precautions (CP) for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) on time to bed assignment, and we investigated the factors influencing infection control policies allowing for discontinuation of CP. The majority of respondents reported an increase in time to bed assignment for patients with a history of MRSA and/or VRE infection or colonization.