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Discontinuing contact precautions for multidrug-resistant organisms: A systematic literature review and meta-analysis
Alexandre R Marra1, Michael B Edmond2, Marin L Schweizer3
1Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, IA; Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Background:
Several single-center studies have suggested that eliminating contact precautions (CPs) for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) control in nonoutbreak settings has no impact on infection rates. We performed a systematic literature review and meta-analysis on the impact of discontinuing contact precautions in the acute care setting.
Methods:
We searched PubMed, CINAHL, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and Embase through December 2016 for studies evaluating discontinuation of contact precautions for multidrug-resistant organisms. We used random-effect models to obtain pooled risk ratio estimates. Heterogeneity was evaluated with I2 estimation and the Cochran Q statistic. Pooled risk ratios for MRSA and VRE were assessed separately.
Results:
Fourteen studies met inclusion criteria and were included in the final review. Six studies discontinued CPs for both MRSA and VRE, 3 for MRSA only, 2 for VRE only, 2 for extended-spectrum β-lactamase-producing Escherichia coli, and 1 for Clostridium difficile infection. When study results were pooled, there was a trend toward reduction of MRSA infection after discontinuing CPs (pooled risk ratio, 0.84; 95% confidence interval, 0.70-1.02; P = .07) and a statistically significant reduction in VRE infection (pooled risk ratio, 0.82; 95% confidence interval, 0.72-0.94; P = .005).
Conclusions:
Discontinuation of CPs for MRSA and VRE has not been associated with increased infection rates.
Insights
Discontinuing contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) in non-outbreak settings did not increase infection rates. This systematic review found a significant reduction in VRE infections and a trend toward reduced MRSA infections.
Area of Science:
- Infectious Diseases
- Epidemiology
- Healthcare-Associated Infections
Background:
- Single-center studies suggest discontinuing contact precautions (CPs) for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) may not impact infection rates.
- Evidence is needed from a broader analysis to confirm these findings in acute care settings.
Purpose of the Study:
- To systematically review and meta-analyze the impact of discontinuing CPs for MRSA and VRE in acute care settings.
- To evaluate the effect of removing CPs on infection rates for multidrug-resistant organisms.
Main Methods:
- A systematic literature search was conducted across multiple databases (PubMed, CINAHL, Cochrane, Embase) up to December 2016.
- Random-effect models were used to calculate pooled risk ratios for MRSA and VRE infection rates after CP discontinuation.
- Heterogeneity was assessed using I² estimation and Cochran Q statistic.
Main Results:
- Fourteen studies met the inclusion criteria.
- A trend toward reduced MRSA infection rates was observed post-discontinuation (pooled RR, 0.84; P=.07).
- A statistically significant reduction in VRE infection rates was found (pooled RR, 0.82; P=.005).
Conclusions:
- Discontinuing CPs for MRSA and VRE in acute care settings is not associated with increased infection rates.
- The findings support the potential to safely discontinue CPs for MRSA and VRE in non-outbreak situations.