Impact Of Contact Precautions Research Articles

Does high adherence to contact precautions lead to low in-hospital transmission of multi-drug-resistant micro-organisms in the endemic setting?

Conflicting results have been published on the impact of contact precautions (CPs) on reduction of transmission of multi-drug-resistant micro-organisms (MDROs) in the endemic setting. Ambiguous definitions coupled with low adherence partly explain these differences. We prospectively monitored the level of adherence to CPs and aimed to relate it to in-hospital transmission of MDROs. Between January 2016 and March 2018, all patients under CPs underwent continuous monitoring of adherence to CPs by routine on-site visits on days 0, 3 and 7 after initiating CPs using a standardized checklist. The protocol included 10 interventions that were routinely checked such as CP sign at the door as well as wearing of gowns and gloves upon entry to the patient room. Patients requiring CPs were defined as colonized or infected with MDROs (meticillin-resistant Staphylococcus aureus (MRSA), non-Escherichia coli extended-spectrum beta lactamase (ESBL) Enterobacterales, vancomycin-resistant enterococci (VRE) and carbapenem-resistant Gram-negative micro-organisms (CRGN)) as well as patients infected with respiratory viruses, norovirus, scabies and hypervirulent strains of Clostridioides difficile. Overall, data from 13,756 CP records from 1378 visits of 812 patients were analysed. Adherence varied between 93% and 100% for each intervention, except for "separate space for contaminated material" with an adherence of 5.3-6.1%. The incidence of in-hospital transmission during the study period was extremely low for MRSA, VRE, non-E.coli ESBL Enterobacterales and CRGN with 0.00-0.064 cases/1000 patient days. High adherence coupled with continuous monitoring of CPs correlated with a very low in-hospital transmission rate. These results indicate that CPs are highly effective if routine monitoring of adherence is implemented.

The Effectiveness of Contact Precautions on Methicillin-Resistant Staphylococcus aureus in Long-term Care Across the United States.

Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of health care-associated infections in long-term care facilities (LTCFs). The Centers for Disease Control and Prevention recommends contact precautions for the prevention of MRSA within acute care facilities, which are being used within the United States Department of Veterans Affairs (VA) for LTCFs in a modified fashion. The impact of contact precautions in long-term care is unknown. To evaluate whether contact precautions decreased MRSA acquisition in LTCFs, compared to standard precautions, we performed a retrospective effectiveness study (pre-post, with concurrent controls) using data from the VA health-care system from 1 January 2011 until 31 December 2015, 2 years before and after a 2013 policy recommending a more aggressive form of contact precautions. Across 75 414 patient admissions from 74 long-term care facilities in the United States, the overall unadjusted rate of MRSA acquisition was 2.6/1000 patient days. Patients were no more likely to acquire MRSA if they were cared for using standard precautions versus contact precautions in a multivariable, discrete time survival analysis, controlling for patient demographics, risk factors, and year of admission (odds ratio, 0.97; 95% confidence interval, .85-1.12; P = .71). MRSA acquisition and infections were not impacted by the use of active surveillance and contact precautions in LTCFs in the VA.

Contact precautions for colonisation with multidrug-resistant organisms and haemodialysis patient quality of life and mood: a pilot case-control study

Background: The rate of multidrug-resistant organisms (MDRO) colonisation in dialysis populations has increased over time. This study aimed to assess the effect of contact precautions and isolation on quality of life and mood for haemodialysis (HD) patients colonised with MDRO. Methods: Patients undergoing facility HD completed the Kidney Disease Quality of Life (KDQOL–SFTM), Beck Depression Inventory (BDI) and Personal Wellbeing-Index Adult (PWI-A). Patients colonised with MDRO were case-matched by age and gender with patients not colonised. Results: A total of 16 MDRO-colonised patients were matched with 16 controls. Groups were well matched for demographics and co-morbidities, other than a trend for older dialysis vintage in the MDRO group [7.2 years (interquartile range 4.6–10.0) compared to 3.2 (1.4–7.6) years, p=0.05]. Comparing MDRO-positive with negative patients, physical (30.5±10.7 vs. 34.6±7.3; p=0.2) and mental (46.5±11.2 vs. 48.5±12.5; p = 0.6) composite scores were not different between groups. The MDRO group reported poorer sleep quality (p=0.01) and sleep patterns (p=0.05), and lower social function (p=0.02). BDI scores were similar (MDRO-positive 10(3.5–21.0) vs. MDRO-negative 12(6.5–16.0), p=0.6). PWI-A scores were also similar in both groups; however, MDRO patients reported lower scores for “feeling safe”, p=0.03. Conclusion: While overall scores of quality of life and depression were similar between groups, the MDRO group reported poorer outcomes in sleep and social function. A larger cohort and qualitative interviews may give more detail of the impact of contact precautions and isolation on HD patients. The necessity for contact precautions for different MDRO needs consideration.

2186. High Adherence to Contact Precautions of Patients with Multidrug-resistant Organisms (MDRO) and Low In-Hospital Transmission of MDROs

BackgroundConflicting results have been published on the impact of contact precautions, as outlined by CDC, HIPAC and ESCMID guidelines, on reduction of transmission of multidrug-resistant organisms (MDRO). Ambiguous definitions coupled with low adherence to these partly explain the differences on impact of contact precautions on transmission of MDROs. We therefore monitored compliance with contact precautions and correlated the level of adherence with in-hospital transmission of MDROs.MethodsBetween January 2016 and March 2018, all patients under contact precautions underwent routine monitoring of adherence to contact precautions by routine on site visits on day 0 (+1), 3 (+/−1) and 7(+/−3) after initiating of contact precautions using a predefined standardized checklist. The protocol includes 10 interventions that are routinely checked such as contact precaution sign at the door and wearing gowns and gloves before entering the room. Patients requiring contact precautions were defined as colonized or infected with MDROs (MRSA, non-E. coli ESBL-Enterobacteriaceae (NEC-ESBL), VRE and carbapenemase-producing organisms) as well as patients infected with RSV, norovirus and hypervirulent strains of C. difficile.ResultsOverall, data of 1,414 visits of 812 patients under contact precautions were assessed. During the observation period, overall adherence was between 93–99% for each intervention, except for separate space for contaminated material with a very low adherence between 5.4 and 6.1%. The incidence of in-hospital transmission was extremely low for MRSA, VRE and NEC-ESBL with 0.02–0.1/100,000 patient days.ConclusionContinuous monitoring of the quality of contact precautions showed excellent overall adherence correlating with a very low in-hospital transmission of MDROs, encouraging monitoring as an integrated part of contact precautions.Disclosures All authors: No reported disclosures.

Advances in prevention and treatment of vancomycin-resistant Enterococcus infection.

This article reviews data, particularly from the last 2 years, addressing the prevention and treatment of vancomycin-resistant Enterococcus (VRE). We focus on infection control, particularly active screening, use of contact precautions as well as pharmacologic options for therapy. This is timely given the evolving priorities in efforts towards the prevention and treatment of multidrug-resistant organisms globally. Key findings include new data regarding the impact of contact precautions on the incidence of VRE colonization and bloodstream infection, new laboratory screening methods, and novel decolonization strategies and treatments. Additional and specific measures beyond standard precautions for infection prevention of VRE remain controversial. Horizontal measures such as chlorhexidine bathing appear beneficial, as are nontouch environmental cleaning methods. Treatment options for invasive disease have improved considerably in the last decade. Decolonization strategies require further research. Overall, the threat of VRE seems exaggerated.

Impact of contact precautions on falls, pressure ulcers and transmission of MRSA and VRE in hospitalized patients

Hospitals use contact precautions to prevent the spread of meticillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). There is concern that contact precautions may have adverse effects on the safety of isolated patients. In November 2010, the infection control policy at an academic medical centre was modified, and contact precautions were discontinued for patients colonized or infected with MRSA or VRE (MRSA/VRE patients). To assess the rates of falls and pressure ulcers among MRSA/VRE patients and other adult medical-surgical patients, as well as changes in MRSA and VRE transmission before and after the policy change. A single-centre retrospective hospital-wide cohort study was performed from 1st November 2009 to 31st October 2011. Rates of falls and pressure ulcers were significantly higher among MRSA/VRE patients compared with other adult medical-surgical patients before the policy change (falls: 4.57 vs 2.04 per 1000 patient-days, P < 0.0001; pressure ulcers: 4.87 vs 1.22 per 1000 patient-days, P < 0.0001) and after the policy change (falls: 4.82 vs 2.10 per 1000 patient-days, P < 0.0001; pressure ulcers: 4.17 vs 1.19 per 1000 patient-days, P < 0.0001). No significant differences in the rates of falls and pressure ulcers among MRSA/VRE patients were found after the policy change compared with before the policy change. There was no overall change in MRSA or VRE hospital-acquired transmission. MRSA/VRE patients had higher rates of falls and pressure ulcers compared with other adult medical-surgical patients. Rates were not affected by removal of contact precautions, suggesting that other factors contribute to these complications. Further research is required among this population to prevent complications.

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.