Veronica Richards1, Elizabeth Tremblay2. 1. Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL; Department of Infection Prevention and Control, University of Florida Health Shands Hospital, Gainesville, FL. Electronic address: vrichh@ufl.edu. 2. Department of Infection Prevention and Control, University of Florida Health Shands Hospital, Gainesville, FL.
Abstract
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for many hospital-associated infections. Both MRSA-colonized and MRSA-infected patients must be isolated on contact precautions per the Centers for Disease Control and Prevention guidelines. This study evaluates the current practice for removing MRSA-colonized patients from contact precautions and proposes a new protocol to decrease inconsistencies with screening methodologies. METHODS: This was a retrospective chart review of MRSA screening swabs collected at an academic medical center between January 1, 2010 and December 31, 2017. Of those patients with MRSA screening swabs, extra-nasal cultures were also evaluated for MRSA infection. Screening swabs were analyzed for appropriateness of order and timing between swabs and active infections. Analysis of variance and the χ² tests were used to determine significance between groups. RESULTS: This study included 8,310 patients with a combined total of 11,601 nasal swabs. Significantly more (P = .0159) patients with 2 negative nasal swabs returned with a recurrent MRSA infection or colonization than those who had 3 consecutive negative nasal swabs (27.8% vs 17.0%, respectively). Additionally, 47.8% of patients only had 1 appropriately ordered negative nasal swab, indicating that a nurse-driven protocol may be more effective in obtaining the full series of samples required to remove contact precautions. CONCLUSIONS: The current practice for removing a patient from contact precautions for MRSA is insufficient. The number of negative nasal swabs required should be increased from 2 to 3 and a decolonization protocol should be implemented.
BACKGROUND:Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for many hospital-associated infections. Both MRSA-colonized and MRSA-infectedpatients must be isolated on contact precautions per the Centers for Disease Control and Prevention guidelines. This study evaluates the current practice for removing MRSA-colonized patients from contact precautions and proposes a new protocol to decrease inconsistencies with screening methodologies. METHODS: This was a retrospective chart review of MRSA screening swabs collected at an academic medical center between January 1, 2010 and December 31, 2017. Of those patients with MRSA screening swabs, extra-nasal cultures were also evaluated for MRSA infection. Screening swabs were analyzed for appropriateness of order and timing between swabs and active infections. Analysis of variance and the χ² tests were used to determine significance between groups. RESULTS: This study included 8,310 patients with a combined total of 11,601 nasal swabs. Significantly more (P = .0159) patients with 2 negative nasal swabs returned with a recurrent MRSA infection or colonization than those who had 3 consecutive negative nasal swabs (27.8% vs 17.0%, respectively). Additionally, 47.8% of patients only had 1 appropriately ordered negative nasal swab, indicating that a nurse-driven protocol may be more effective in obtaining the full series of samples required to remove contact precautions. CONCLUSIONS: The current practice for removing a patient from contact precautions for MRSA is insufficient. The number of negative nasal swabs required should be increased from 2 to 3 and a decolonization protocol should be implemented.
Authors: David B Banach; Gonzalo Bearman; Marsha Barnden; Jennifer A Hanrahan; Surbhi Leekha; Daniel J Morgan; Rekha Murthy; L Silvia Munoz-Price; Kaede V Sullivan; Kyle J Popovich; Timothy L Wiemken Journal: Infect Control Hosp Epidemiol Date: 2018-01-11 Impact factor: 3.254
Authors: Jennifer C Goldsack; Christine DeRitter; Michelle Power; Amy Spencer; Cynthia L Taylor; Sofia F Kim; Ryan Kirk; Marci Drees Journal: Am J Infect Control Date: 2014-10 Impact factor: 2.918
Authors: B Y Lee; A Singh; M Z David; S M Bartsch; R B Slayton; S S Huang; S M Zimmer; M A Potter; C M Macal; D S Lauderdale; L G Miller; R S Daum Journal: Clin Microbiol Infect Date: 2012-06-19 Impact factor: 8.067
Authors: Erica S Shenoy; Jiyeon Kim; Eric S Rosenberg; Jessica A Cotter; Hang Lee; Rochelle P Walensky; David C Hooper Journal: Clin Infect Dis Date: 2013-04-09 Impact factor: 9.079