May 11, 2022
By Zeina Kanafani, MD, MS, FIDSA
The Centers for Disease Control and Prevention continues to recommend contact precautions for patients infected or colonized with methicillin-resistant Staphylococcus aureus (MRSA) to prevent transmission of the organism in health care settings. However, recent evidence has accumulated that challenges the time- and cost-effectiveness of this practice. In an article in the American Journal of Infection Control, the investigators conducted a retrospective quasi-experimental study to determine the effect of discontinuing contact precautions on the MRSA hospital-acquired infection (HAI) rates at a tertiary care center. The intervention consisted of the discontinuation of contact precautions in the setting of MRSA infection. All HAI rates were compared in the preintervention and postintervention periods, including central line-associated bloodstream infections (CLABSIs) and MRSA LabID bacteremia events (MRSA LabIDs) as primary outcome variables and catheter-associated urinary tract infections (CAUTIs), ventilator-associated pneumonia (VAP), surgical site infections (SSIs), and hospital-acquired pneumonia (HAP) as secondary outcomes.
A total of 295 patients were included in the analysis: 120 in the preintervention group and 175 in the postintervention group. The use of medical devices was not different before and after the intervention (97.29% vs. 97.50%; P = 1). In patients who developed HAIs, length of stay was longer in the postintervention than the preintervention period (41.93 ± 46.61 vs. 29.27 ± 22.50 days; P = .0021). All other patient characteristics were similar in both groups.
There were 399 MRSA infections during the time of the study (50 CLABSIs, 204 MRSA LabID events, 3 CAUTIs, 14 SSIs, 9 VAPs, and 119 HAPs). There were no differences in the primary and secondary outcomes when comparing the preintervention and postintervention periods except for SSI rates, which decreased by 72%. The discontinuation of contact precautions resulted in cost savings of $139,228 per year. Mortality rates did not differ with the discontinuation of precautions (overall mortality and mortality related to the various types of infections).
Despite the obvious limitations of the study (single center, retrospective, low event rates of some HAIs), the results suggest that discontinuation of contact precautions in the setting of MRSA infection is both safe and cost-saving in the long run. Prospective randomized trials are needed to validate the findings of this study.