Background: Healthcare-associated infections (HAIs) remain a significant problem. MRSA and VRE are one of the most common causes of HAIs. Patients colonized with MRSA or VRE are at increased risk of infection. Contact precautions are currently recommended for patients infected with either organism. These precautions might reduce transmission but can be associated with adverse events and significant cost.
Methods: Study was conducted in four units (two medical floors, surgical and medical ICUs), in a 900 bed tertiary medical center in North Alabama. All patients infected with VRE or MRSA had 5 days of whole body decolonization with chlorehexidine 4% solution and placed in contact precautions for 3 days followed by universal gloving for the remainder of hospitalization. Patients with an infected draining wound were excluded.
Results: The study was conducted from 8/2014 to 2/2015, compared with a pre-study period from 1/2014 to 7/2014. Total hospital admissions were 141,530 compared to 145,655 during the study period. Total admissions for the participating units were 19,799 and 20,881 for pre-study and study periods, respectively. During the pre-study period, the participating units had 86 MRSA infected patients (community onset (CO): 65; Healthcare associated (HA): 21), but only 73 patients (CO: 64; HA: 9) during study period. Total VRE cases during the pre-study period were 19 (CO: 11; HA: 8) compared to 10 cases during the study period (CO: 7; HAI: 3). Mean isolation days were reduced by 42% for MRSA (11.9 to 6.8) and 34% for VRE (12.8 to 8.4). The average cost of gowns was $26 per patient per day. By implementing this protocol, we reduced the total hospital monthly expenditure on isolation gowns by $7646 and $9058 for VRE and MRSA patients, respectively. MRSA and VRE healthcare-associated infection rates were reduced by 57% and 62%, respectively.
Conclusion: Implementation of this decolonization protocol with fewer contact precaution days for MRSA and VRE patients might reduce cost, isolation days, adverse events and infection rates. Patient satisfaction and healthcare professional compliance increased during the study period. Further studies are needed to confirm the clinical utility of this protocol and its benefits.
K. Hansen, None
A. Hassoun, None