Does the Removal of Contact Precautions for MRSA and VRE Infected Patients Change Health Care-Associated Infection Rate?: A Systematic Review and Meta-Analysis.

Authors

Robert Kleyman, HCA HealthcareFollow
Sophia Cupril-Nilson, HCA HealthcareFollow
Kent Robinson
Shaival Thakore, HCA HealthcareFollow
Furqan Haq, HCA HealthcareFollow
Liwei Chen, HCA HealthcareFollow
Olu Oyesanmi, HCA HealthcareFollow
Kimberly D. Browning, HCA HealthcareFollow
Joseph Pino, HCA HealthcareFollow
Rahul Mhaskar, HCA HealthcareFollow

Division

West Florida

Hospital

Regional Medical Center Bayonet Point

Document Type

Manuscript

Publication Date

12-1-2020

Keywords

Hospital-associated infectio, Methicillin-resistant Staphylococcus aureus, Vancomycin-resistant Enterococcus

Disciplines

Bacterial Infections and Mycoses | Infectious Disease | Quality Improvement

Abstract

OBJECTIVE: Update existing meta-analysis to analyze if discontinuation of contact precautions (CPs) for Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin resistant Enterococcus (VRE) colonization or infection affects hospital-associated MRSA or VRE infection rates.

METHODS: We conducted a systematic review of 17 studies evaluating discontinuation of CPs for MRSA and VRE. Random-effects and fixed-effects models were used to determine the pooled risk ratios (RR) of preincidence hospital-associated infection rate to postincidence rate. Subgroup analysis was used to assess sources of heterogeneity.

RESULTS: No significant difference between rates of hospital-associated MRSA infection before and after stopping the CPs was observed (RR, 0.84; 95% confidence internal [CI], 0.71-1.01; P = .06). An inverse association was observed between discontinuation of CPs and rates of hospital-associated VRE infection (RR, 0.82; 95% CI, 0.72-0.94; P = .005). A subgroup analysis of 6 studies that used chlorhexidine, showed no difference between rates of hospital-associated MRSA infection with discontinuation of CPs (RR, 0.83; 95% CI, 0.69-1.00; P = .05). In 5 studies that did not use chlorhexidine, there was no difference between rates of hospital-associated MRSA infection with discontinuation of CPs (RR, 1.02; 95% CI, 0.55-1.88; P= .95).

CONCLUSIONS: There was no significant difference in rates of hospital-associated MRSA infection before and after removing CPs. Additionally, there were decreased rates of hospital-associated VRE infection following stoppage of CPs.

Publisher or Conference

American Journal of Infection Control

Recommended Citation

Kleyman R, Cupril-Nilson S, Robinson K, et al. Does the removal of contact precautions for MRSA and VRE infected patients change health care-associated infection rate?: A systematic review and meta-analysis [published online ahead of print, 2020 Dec 1]. Am J Infect Control. 2020;S0196-6553(20)31029-4. doi:10.1016/j.ajic.2020.11.020