Lifting Contact Precautions for Methicillin Resistant Staphylococcus aureus (MRSA) Isolation: Effect on MRSA Infection Measures

Background: Despite widespread utilization of contact precautions for endemic MRSA control, there is no direct evidence available regarding the efficacy of this measure to reduce HAIs. This study reports the findings of replacing MRSA contact with standard precautions and introducing chlorhexidine-gluconate (CHG) bathing for all inpatients.

Methods: The impact of discontinuing MRSA contact precautions was assessed in a pre/post design over a 13 month time period in a tertiary care hospital. MRSA outcome measures were clinical bacteremia, CLABSI, CAUTI, pVAP, SSI, healthcare associated pneumonia (HAP), and MRSA high risk patient surveillance screening (admission and transfer screening to ICUs). Projected cost savings were calculated.

Results: MRSA contact precautions were lifted mid-September 2015 (month not included in analysis). No increases in MRSA bacteremia (OR: 0.62 [95%CI: 0.27, 1.44]; p=0.30), CLABSI (OR: 1.61 [0.53, 4.92]; p=0.42), and HAP (OR: 1.07 [0.44, 2.64]; p=1.00) were observed in the following six months. There were no MRSA CAUTI pre and post intervention and one pVAP MRSA detected pre intervention with none detected post intervention. MRSA SSI (deep, organ space, superficial) decreased significantly (OR: 0.35 [0.20, 0.64]; p=0.35) with superficial SSIs showing the highest reduction (OR: 0.24 [0.08, 0.72]; p=0.0064) followed by deep (OR: 0.30 [0.10, 0.91]; p=0.029, and organ space SSIs (OR: 0.56 [0.22, 1.43]; p=0.26). Surveillance screening revealed a non-significant increase in MRSA conversion rate (OR: 1.20 [0.70, 2.06]; p=0.58). Based on an isolation rate of 10% for MRSA in the pre intervention phase and an estimated average of 25 room entries/day requiring gowns and gloves, a total annual savings of $80,000 to $230,000 were calculated taking into account different gown and gloves types and subtracting the additional costs of CHG soap.

Conclusion: Replacement of contact with standard precautions for MRSA combined with the introduction of CHG bathing of all inpatients did not negatively affect occurrence of MRSA HAIs. Besides substantial cost savings, this may improve patient satisfaction by easier access and less stigmatization, and reduce personnel time used for donning and removal of gowns and gloves.