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Updated: Oct 11, 2025
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Discontinuing MRSA and VRE contact precautions: Defining hospital characteristics and infection prevention practices
Elise M Martin1,2, Bonnie Colaianne3, Christine Bridge3
1Department of Infection Prevention and Control, UPMC Presbyterian, Pittsburgh, Pennsylvania.
Objective:
To define conditions in which contact precautions can be safely discontinued for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE).
Design:
Interrupted time series.
Setting:
15 acute-care hospitals.
Participants:
Inpatients.
Intervention:
Contact precautions for endemic MRSA and VRE were discontinued in 12 intervention hospitals and continued at 3 nonintervention hospitals. Rates of MRSA and VRE healthcare-associated infections (HAIs) were collected for 12 months before and after. Trends in HAI rates were analyzed using Poisson regression. To predict conditions when contact precautions may be safely discontinued, selected baseline hospital characteristics and infection prevention practices were correlated with HAI rate changes, stratified by hospital.
Results:
Aggregated HAI rates from intervention hospitals before and after discontinuation of contact precautions were 0.14 and 0.15 MRSA HAI per 1,000 patient days (P = .74), 0.05 and 0.05 VRE HAI per 1,000 patient days (P = .96), and 0.04 and 0.04 MRSA laboratory-identified (LabID) events per 100 admissions (P = .57). No statistically significant rate changes occurred between intervention and non-intervention hospitals. All successful hospitals had low baseline MRSA and VRE HAI rates and high hand hygiene adherence. We observed no correlations between rate changes after discontinuation and the assessed hospital characteristics and infection prevention factors, but the rate improved with higher proportion of semiprivate rooms (P = .04).
Conclusions:
Discontinuing contact precautions for MRSA/VRE did not result in increased HAI rates, suggesting that contact precautions can be safely removed from diverse hospitals, including community hospitals and those with lower proportions of private rooms. Good hand hygiene and low baseline HAI rates may be conditions permissive of safe removal of contact precautions.
Insights
Contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) can be safely discontinued. Removing these precautions did not increase healthcare-associated infection rates in hospitals with good hand hygiene and low baseline infection rates.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Infection Prevention and Control
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) are significant healthcare-associated pathogens.
- Contact precautions are a key strategy to limit the transmission of multidrug-resistant organisms (MDROs).
- The optimal duration and conditions for discontinuing contact precautions for endemic MRSA and VRE remain debated.
Purpose of the Study:
- To determine the conditions under which contact precautions for MRSA and VRE can be safely discontinued.
- To evaluate the impact of discontinuing contact precautions on healthcare-associated infection (HAI) rates.
- To identify hospital characteristics and infection prevention practices associated with safe discontinuation.
Main Methods:
- An interrupted time series design was employed across 15 acute-care hospitals.
- Contact precautions for MRSA and VRE were discontinued in 12 intervention hospitals and continued in 3 control hospitals.
- Healthcare-associated infection rates were analyzed for 12 months pre- and post-intervention using Poisson regression.
Main Results:
- Discontinuing contact precautions did not lead to a statistically significant increase in MRSA or VRE HAI rates in intervention hospitals.
- No significant differences in HAI rate changes were observed between intervention and non-intervention hospitals.
- Hospitals with successful discontinuation had low baseline HAI rates and high hand hygiene adherence; a higher proportion of semiprivate rooms was also associated with improved rates.
Conclusions:
- Contact precautions for MRSA and VRE can be safely discontinued in various hospital settings, including community hospitals.
- Low baseline HAI rates and high hand hygiene adherence appear to be permissive conditions for safe removal of contact precautions.
- These findings suggest a potential shift in infection control strategies for endemic MDROs.
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