277. Cessation of Contact Isolation for Endemic MRSA and VRE is Not Associated with Increased Infections
Session: Poster Abstract Session: HAI: MSSA, MRSA, and other Gram-Positives
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • IDWeek Poster Contact Isolation-FINAL 10-20-2016.pdf (70.3 kB)
  • Background:  Contact isolation precautions are recommended to prevent the transmission of MRSA and VRE. However, when infection prevention measures such as hand hygiene, environmental cleaning, and chlorohexidine (CHG) patient bathing are in place, it is unclear whether routine use of contact isolation precautions is needed.

    Methods: Acquisition or infection due to MRSA or VRE were monitored via two methods: 1) CDC NHSN reporting of MRSA and VRE bacteremia with designation as hospital onset or community onset; 2) Characterization of routine clinical cultures by an experienced infection preventionist (IP). In January 2015, routine contact isolation precautions for endemic MRSA and VRE were suspended. The hospital-wide monthly rates of MRSA and VRE acquisition and infection from 2014-2015 were analyzed by Poisson regression to determine whether the change in practice was associated with a change in infection rates.

    Results:There was no significant difference in the rate of acquisition or infection due to MRSA or VRE when comparing rates in the 12 months before and after the cessation of routine contact isolation precautions. Table 1 catalogs the rate of acquisition and infection due to MRSA and VRE for 2014 and 2015. High rates of hand hygiene (2014: 93.5% compliance, 2015: 91.4% compliance) and environmental cleaning (2014: 93.6% of 22805 surfaces cleaned, 2015: 96.3% of 27411 surfaces cleaned) were documented. The method of CHG bathing and monitoring program were changed during the observation period precluding comparison.

    Measurement Method

    Year

    MRSA/1000 patient days

    Model Estimated risk of MRSA (compared to 2014) (95% CI)

    P Value

    CDC NHSN Hospital Onset MRSA Bacteremia

    2014

    0.18

     

     

    2015

    0.18

    0.972 (0.553-1.706)

    0.920

    CDC NHSN Community Onset MRSA Bacteremia

    2014

    0.34

     

     

    2015

    0.39

    1.159 (0.779-1.723)

    0.468

    IP Defined HA MRSA 

    2014

    0.55

     

     

    2015

    0.48

    0.881 (0.639-1.217)

    0.443

     

    Year

    VRE/1000 patient days

    Model Estimated risk of VRE (compared to 2014) (95% CI)

    P Value

    CDC NHSN Hospital Onset VRE Bacteremia

    2014

    0.07

     

     

    2015

    0.08

    1.056 (0.445-2.505)

    0.902

    CDC NHSN Community Onset VRE Bacteremia

    2014

    0.07

     

     

    2015

    0.1

    1.484 (0.629-3.501)

    0.367

    IP Defined HA VRE  

    2014

    0.45

     

     

    2015

    0.32

    0.705 (0.483-1.030)

    0.071

    Conclusion: When hand hygiene, environmental cleaning, and CHG bathing are adequately maintained, routine contact isolation for endemic MRSA and VRE is unnecessary.

    Mark E. Rupp, MD, FIDSA, FSHEA1, Teresa Fitzgerald, RN2, Trevor Van Schooneveld, MD3, Angela Hewlett, MD, MS, FIDSA1, Ryan Clevenger, BS4 and Elizabeth Lyden, MS5, (1)Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, (2)Nebraska Medicine, Omaha, NE, (3)University of Nebraska Medical Center, Omaha, NE, (4)Infection Control & Epidemiology, Nebraska Medicine, Omaha, NE, (5)Epidemiology, University of Nebraska Medical Center, Omaha, NE

    Disclosures:

    M. E. Rupp, None

    T. Fitzgerald, None

    T. Van Schooneveld, None

    A. Hewlett, None

    R. Clevenger, None

    E. Lyden, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.