Elimination of Routine Contact Precautions for Endemic Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus: A Retrospective Quasi-Experimental Study
Elimination of Routine Contact Precautions for Endemic Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus: A Retrospective Quasi-Experimental Study
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DOI：
10.1017/ice.2016.156
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发表时间：
2016-11-01
影响因子：
4.5
通讯作者：
Uslan, Daniel Z.
中科院分区：
文献类型：
--
作者：
Martin, Elise M.;Russell, Dana;Uslan, Daniel Z.
客观的。评估停止针对耐甲氧西林金黄色葡萄球菌 (MRSA) 和耐万古霉素肠球菌 (VRE) 的接触预防措施 (CP) 以及扩大葡萄糖酸氯己定 (CHG) 使用对卫生系统的影响。设计。回顾性、非随机、观察性、准实验研究。设置。加利福尼亚州的两家医院。参与者。住院病人。方法。我们比较了地方性 MRSA 和 VRE 常规 CP 停止以及 CHG 沐浴扩大到所有病房前后 1 年全院实验室确定的临床培养率（作为医疗保健相关感染的标志）。收集患者的培养数据和材料利用的成本数据。使用时间驱动的基于活动的成本法对穿戴个人防护设备所花费的护理时间进行评估和量化。结果。停止 CP 之前和之后，MRSA 的平均阳性培养率分别为 0.40 和 0.32 个培养物/100 名入院者 (P = .09)，以及 VRE 的 0.48 和 0.40 个培养物/100 名入院者 (P = .14)。将隔离服和 CHG 成本结合起来，卫生系统在一年内节省了 643,776 美元。变更之前，28.5% 的重症监护室和 19% 的内科/手术床位因 MRSA/VRE 接受 CP 治疗。根据平均进入房间和穿戴时间，在变更之前穿戴 MRSA/VRE 个人防护设备所花费的护理时间估计为 45,277 小时/年（估计成本为 460 万美元）。结论。停止针对地方性 MRSA 和 VRE 的常规 CP 治疗并不会导致 1 年后 MRSA 或 VRE 发病率增加。由于节省了材料成本、减少了医护人员的时间，并且可能的感染不会随之增加，因此取消常规 CP 可能会为住院护理服务带来巨大的价值。
OBJECTIVE. To evaluate the impact of discontinuation of contact precautions (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. Two California hospitals.PARTICIPANTS. Inpatients.METHODS. We compared hospital-wide laboratory-identified 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 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 = .09), and 0.48 and 0.40 cultures/100 admissions for VRE (P = .14). When combining isolation gown and CHG costs, the health system saved $643,776 in 1 year. Before the change, 28.5% intensive care unit and 19% medicine/surgery beds were on CP for MRSA/VRE. On the basis of average room entries and donning time, estimated nursing time spent donning personal protective equipment 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 1 year. With cost savings on materials, decreased healthcare worker time, and no concomitant increase in possible infections, elimination of routine CP may add substantial value to inpatient care delivery.