1961. Incidence of Nosocomial Staphylococcus aureus Infections after Suspension of Contact Precautions (CP) for Methicillin-Resistant S. aureus (MRSA)
Session: Oral Abstract Session: Controlling Resistant Gram Positive Infections
Saturday, October 10, 2015: 2:15 PM
Room: 5--AB
Background:

Risks and benefits of CP in preventing nosocomial transmission of MRSA and vancomycin-resistant Enterococcus (VRE) infections are a matter of debate.  More treatment options for these infections are available today than in the past.  High numbers of patients on CP place strain on bed availability, especially in hospitals with semi-private rooms and high census.  Adherence to precautions diminishes as the prevalence of patients on CP increases.  Focus of prevention efforts on MRSA and VRE fails to address transmission of other pathogens, including MSSA. A number of hospitals have discontinued CP for MRSA and VRE infections and colonization.

Methods:

Strong Memorial Hospital, an 800-bed university teaching hospital, discontinued CP for patients with MRSA or VRE infection or colonization in August 2014.  Screening for carriage of these organisms is not performed, except for pre-operative MRSA screening to inform selection of surgical antibiotic prophylaxis.  CP is required for patients with wound drainage that cannot be contained, regardless of specific pathogen. The incidence of MRSA and MSSA among hospitalized patients is tracked using the microbiology database.  Nosocomial infection is defined as a first positive culture from a clinical specimen after the third calendar day in hospital (1 episode per patient).

Results:

For the baseline period Jan 2013 - July 2014 and the study period Aug 2014 - Mar 2015 (after discontinuation of CP for MRSA and VRE), nosocomial MRSA and MSSA infections per 10,000 patient-days are shown in the table.  Projected cost savings for gowns and gloves are $255,000/year after discontinuation of CP.  When CP was in effect, an average 20 patients/month were transferred between rooms to accommodate CP for patients with MRSA and VRE.

Table.  Nosocomial infections per 10,000 patient-days

 

MRSA

MSSA

 

All source

Bacteremia

All source

Bacteremia

Baseline

1/1/13-7/31/14

3.56

0.06

4.84

1.07

No contact precautions

8/1/14-3/31/15

3.56

0.05

5.03

1.15

Conclusion:

CP for patients infected or colonized with MRSA can be discontinued without discernible impact on the incidence of nosocomial MRSA infection.   Moreover, MSSA exceeds MRSA as a nosocomial pathogen; a horizontal approach to infection prevention is likely to be more effective.

Paul Graman, MD, FIDSA, FSHEA1, Mark Shelly, MD, FSHEA2, Ann Marie Pettis, RN, BSN, CIC3, Melissa Bronstein, RN, MPA1 and Linda Greene, RN, MPS, CIC4, (1)University of Rochester Medical Center, Rochester, NY, (2)Infectious Disease, University of Rochester Medical Center, Rocheseter, NY, (3)Infection Prevention, UNIVERSITY OF ROCHESTER MEDICAL CENTER, Rochester, NY, (4)Infection Prevention, Highland Hospital, Rochester, NY

Disclosures:

P. Graman, None

M. Shelly, None

A. M. Pettis, None

M. Bronstein, None

L. Greene, None

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