1Division of Infectious Diseases,Virginia Commonwealth University,Richmond,Virginia.
2Division of Epidemiology,Virginia Commonwealth University,Richmond,Virginia.
Infect Control Hosp Epidemiol. 2018 Jun;39(6):676-682. doi: 10.1017/ice.2018.57. Epub 2018 Mar 27.
OBJECTIVETo investigate the impact of discontinuing contact precautions among patients infected or colonized with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) on rates of healthcare-associated infection (HAI).
Single-center, quasi-experimental study conducted between 2011 and 2016.METHODSWe employed an interrupted time series design to evaluate the impact of 7 horizontal infection prevention interventions across intensive care units (ICUs) and hospital wards at an 865-bed urban, academic medical center. These interventions included (1) implementation of a urinary catheter bundle in January 2011, (2) chlorhexidine gluconate (CHG) perineal care outside ICUs in June 2011, (3) hospital-wide CHG bathing outside of ICUs in March 2012, (4) discontinuation of contact precautions in April 2013 for MRSA and VRE, (5) assessments and feedback with bare below the elbows (BBE) and contact precautions in August 2014, (6) implementation of an ultraviolet-C disinfection robot in March 2015, and (7) 72-hour automatic urinary catheter discontinuation orders in March 2016. Segmented regression modeling was performed to assess the changes in the infection rates attributable to the interventions.RESULTSThe rate of HAI declined throughout the study period. Infection rates for MRSA and VRE decreased by 1.31 (P=.76) and 6.25 (P=.21) per 100,000 patient days, respectively, and the infection rate decreased by 2.44 per 10,000 patient days (P=.23) for device-associated HAI following discontinuation of contact precautions.CONCLUSIONThe discontinuation of contact precautions for patients infected or colonized with MRSA or VRE, when combined with horizontal infection prevention measures was not associated with an increased incidence of MRSA and VRE device-associated infections. This approach may represent a safe and cost-effective strategy for managing these patients.Infect Control Hosp Epidemiol 2018;39:676-682.
调查停止耐甲氧西林金黄色葡萄球菌（MRSA）或耐万古霉素肠球菌（VRE）感染或定植患者的接触预防措施对医疗保健相关性感染（HAI）发生率的影响。
2011 年至 2016 年进行的单中心准实验研究。
我们采用中断时间序列设计来评估在 865 张病床的城市学术医疗中心的重症监护病房（ICU）和医院病房中实施 7 项横向感染预防干预措施的影响。这些干预措施包括：（1）2011 年 1 月实施导尿管套件；（2）2011 年 6 月在 ICU 外进行葡萄糖酸洗必泰（CHG）会阴护理；（3）2012 年 3 月在 ICU 外进行全院 CHG 沐浴；（4）2013 年 4 月停止对 MRSA 和 VRE 的接触预防措施；（5）2014 年 8 月进行 bare-below-the-elbows（BBE）评估和接触预防措施反馈；（6）2015 年 3 月实施紫外线-C 消毒机器人；（7）2016 年 3 月实施 72 小时自动导尿管停用医嘱。进行分段回归建模以评估干预措施引起的感染率变化。
HAI 发生率在整个研究期间呈下降趋势。MRSA 和 VRE 的感染率分别下降了 1.31（P=.76）和 6.25（P=.21）/100,000 患者日，停用接触预防措施后，器械相关 HAI 的感染率下降了 2.44/10,000 患者日（P=.23）。
当停止对 MRSA 或 VRE 感染或定植患者的接触预防措施与横向感染预防措施相结合时，不会导致 MRSA 和 VRE 器械相关感染的发生率增加。这种方法可能是管理这些患者的安全且具有成本效益的策略。感染控制与医院流行病学 2018;39:676-682.
