Cessation of Contact Isolation for Endemic MRSA and VRE is Not Associated with Increased Infections

Abstract

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