IDEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City.
JAMA Netw Open. 2021 Mar 1;4(3):e210971. doi: 10.1001/jamanetworkopen.2021.0971.
The effectiveness and importance of contact precautions for endemic pathogens has long been debated, and their use has broad implications for infection control of other pathogens.
To estimate the association between contact precautions and transmission of methicillin-resistant Staphylococcus aureus (MRSA) across US Department of Veterans Affairs (VA) hospitals.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used mathematical models applied to data from a population-based sample of adults hospitalized in 108 VA acute care hospitals for at least 24 hours from January 1, 2008, to December 31, 2017. Data were analyzed from May 2, 2019, to December 11, 2020.
A positive MRSA test result, presumed to indicate contact precautions use according to the VA MRSA Prevention Initiative.
The main outcome was the association between contact precautions and MRSA transmission, defined as the relative transmissibility attributed to contact precautions. A contact precaution effect estimate (<1 indicates a reduction in transmission associated with contact precautions) was estimated for each hospital and then pooled over time and across hospitals using meta-regression.
In this cohort study of 108 VA hospitals, more than 2 million unique individuals had over 5.6 million admissions, of which 14.1% were presumed to have contact precautions with more than 8.4 million MRSA surveillance tests. Pooled estimates found associations between contact precautions and transmission to be stable from 2008 to 2017, with estimated transmission reductions ranging from 43% (95% credible interval [CrI], 38%-48%) to 51% (95% CrI, 46%-55%). Over the entire 10-year study period, contact precautions reduced transmission 47% (95% CrI, 45%-49%), and the intrafacility autocorrelation coefficient estimate was 0.99, suggesting consistent estimates over time within facilities. Larger facilities and those with higher admission screening compliance observed additional reductions in transmission associated with contact precautions (relative rate, 0.84; 95% CI, 0.74-0.96 and 0.74; 95% CI, 0.58-0.96, respectively) compared with smaller facilities and those with lower admission screening compliance. Facilities in the southern US had a smaller transmission reduction attributable to contact precautions (relative rate, 1.14; 95% CI, 1.01-1.28) compared with facilities in other regions in the US.
In this cohort study of adults in VA hospitals, transmissibility of MRSA was found to be reduced by approximately 50% among patients with contact precautions. These results provide an explanation for decreasing acquisition rates in VA hospitals since the MRSA Prevention Initiative.
接触预防措施对于地方性病原体的有效性和重要性一直存在争议，其使用对其他病原体的感染控制具有广泛的影响。
估计接触预防措施与美国退伍军人事务部（VA）医院内耐甲氧西林金黄色葡萄球菌（MRSA）传播之间的关联。
设计、设置和参与者：本回顾性队列研究使用数学模型对 2008 年 1 月 1 日至 2017 年 12 月 31 日期间至少在 108 家 VA 急性护理医院住院至少 24 小时的成人进行基于人群的样本数据进行了应用。数据于 2019 年 5 月 2 日至 2020 年 12 月 11 日进行了分析。
MRSA 检测呈阳性，根据 VA MRSA 预防计划推测表示使用了接触预防措施。
主要结局是接触预防措施与 MRSA 传播之间的关联，定义为接触预防措施归因的相对传染性。为每个医院以及随时间和跨医院进行了接触预防效果估计（<1 表示与接触预防措施相关的传播减少），然后使用元回归进行了汇总。
在这项涉及 108 家 VA 医院的队列研究中，超过 200 万的个体进行了超过 560 万次就诊，其中 14.1%被认为采用了接触预防措施，进行了超过 840 万次 MRSA 监测测试。综合估计结果发现，2008 年至 2017 年期间，接触预防措施与传播之间的关联是稳定的，估计的传播减少范围从 43%（95%可信区间[CrI]，38%-48%）到 51%（95% CrI，46%-55%）。在整个 10 年研究期间，接触预防措施将传播减少了 47%（95% CrI，45%-49%），并且设施内的内部自相关系数估计值为 0.99，这表明在设施内随时间推移存在一致的估计值。与较小的设施和较低的入院筛查依从性相比，较大的设施和具有较高入院筛查依从性的设施观察到与接触预防措施相关的传播减少（相对率分别为 0.84（95%CI，0.74-0.96 和 0.74（95%CI，0.58-0.96）。与美国其他地区的设施相比，美国南部地区设施中归因于接触预防措施的传播减少幅度较小（相对率为 1.14（95%CI，1.01-1.28））。
在这项涉及 VA 医院成人的队列研究中，发现接触预防措施可使 MRSA 的传染性降低约 50%。这些结果解释了自 MRSA 预防计划以来 VA 医院中获得率的下降。
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