UCLA

Objective: Given controversy over use of contact precautions (CP), this study evaluates the impact of discontinuing CP for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) and expansion of chlorhexidine gluconate (CHG) use on the health system.

Design: Retrospective, nonrandomized, observational, quasi-experimental study.

Setting: 2 California hospitals.

Participants: Inpatients.

Methods: We compared hospital-wide LabID clinical culture rates (as a marker of healthcare associated infections) 1 year before and after routine CP for endemic MRSA and VRE were discontinued and CHG bathing was expanded to all units. Culture data from patients and cost data on material utilization were collected. Nursing time spent donning personal protective equipment (PPE) was assessed and quantified using time-driven activity-based costing.

Results: Average positive culture rates before and after discontinuing CP were 0.40 and 0.32 cultures/100 admissions for MRSA (p=0.09), and 0.48 and 0.40 cultures/100 admissions for VRE (p=0.14). When combining isolation gown and CHG costs, the health system saved $643,776 in one year. Prior to the change, 28.5% ICU and 19% Medicine/Surgery beds were on CP for MRSA/VRE. Based on average room entries and donning time, estimated nursing time spent donning PPE for MRSA/VRE before the change was 45,277 hours/year (estimated cost: $4.6 million).

Conclusion: Discontinuing routine CP for endemic MRSA and VRE did not result in increased rates of MRSA or VRE after one year. With cost savings on materials, increased healthcare worker time, and no concomitant increase in possible infections, elimination of routine CP may add substantial value to inpatient care delivery.