547. Resource Utilization Associated with Bed Allocation for Patients with a History of MRSA and VRE
Session: Poster Abstract Session: MRSA Surveillance and Infection Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Background: 

MRSA and VRE are endemic in hospital settings. Although CDC guidelines require patients with a positive MRSA and/or VRE culture to be on Contact Precautions (CP) -- which requires either a private room or cohorting with another similar patient -- there are no criteria for discontinuation of such precautions. Because little data are available about the impact of CP on the resource utilization associated with hospital bed allocation, our objective was to describe the impact of CP for MRSA/VRE on resource utilization in inpatient facilities in the US.

Methods: 

We electronically surveyed members of the National Association of Healthcare Access Management (NAHAM). All 1,076 NAHAM members with valid email addresses were invited to participate. Participants responded to questions on: hospital characteristics; hospital infection control policies; and the perceived impact of CPs on time-to-bed-assignment.

Results: 

233/1,076 (22%) of Patient Access Managers (PAMs) completed the electronic survey within 5 weeks. Responders represented institutions across all 9 census regions; 62% of respondents were from institutions with greater than 200 licensed beds.

168/233 (72.1%) respondents reported an increase in time to bed assignment for patients with MRSA.  Of these, 46 (27%) reported between 30-120 additional minutes spent, and 10 (6%) reported greater than 120 additional minutes spent finding a bed assignment for an MRSA+ patient.  Mean reported increased time to bed allocation was 24 min for MRSA and 23 min for VRE. Institutional protocols for removal of CP were endorsed by only a minority of respondents; 37% and 33% reported criteria for removal of MRSA CP and VRE CP, respectively. 42/194 (22%) and 36/197 (18%) of respondents reported patients ever reported as MRSA or VRE positiver emained so, in their hospital,  “for life.”

Conclusion: 

PAMs report that patients requiring CP are a perceived resource burden and require increased time to bed assignment. Despite this burden, there are no nationally-endorsed policies that address discontinuation of CP. Given the increasing prevalence of MRSA and VRE, policy makers should address the consequent resource utilization implications and implement guidelines for discontinuation of contact precautions.  


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Erica S. Shenoy, MD, PhD, Medicine, Div Infectious Diseases, Massachusetts General Hospital, Boston, MA, Benjamin Orcutt, CHAM, Admitting Services, Massachusetts General Hospital, Boston, MA, Rochelle Walensky, MD, MPH, FIDSA, Division of HIV Epidemiology and Outcomes Research, Massachusetts General Hospital - Havard Medical School, Boston, MA, Hang Lee, PhD, Biostatistics, Massachusetts General Hospital, Boston, MA and David Hooper, MD, Massachusetts General Hospital, Boston, MA

Disclosures:

E. S. Shenoy, None

B. Orcutt, NAHAM: Member, none

R. Walensky, None

H. Lee, None

D. Hooper, None

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