A study of Veterans Administration (VA) long-term care facilities (LTCFs) has found that active surveillance and use of contact precautions had no impact on methicillin-resistant Staphylococcus aureus (MRSA) acquisition and infection.
The study, published today in Clinical Infectious Diseases, looked at more than 75,000 patient admissions at 74 VA LTCFs over a 5-year period and found that patients were no more likely to acquire MRSA in facilities that require healthcare workers to use gowns and gloves when caring for MRSA patients than in facilities that use standard precautions.
MRSA is a primary cause of healthcare-associated infections (HAIs) and has long been a problem in healthcare settings because it spreads easily between patients and healthcare workers. Patients who are colonized with MRSA can spread the bacteria by contaminating bed rails and linens, bathroom fixtures, and other parts of the hospital environment, and healthcare workers can compound the problem if they don't clean their hands properly.
To reduce the spread of the pathogen in hospitals, both the US Centers for Disease Control and Prevention and the VA recommend the use of gloves and gowns at acute care hospitals for all contact with residents colonized or infected with MRSA. Whether these contact precautions prevent patients in acute care from getting MRSA is debated.
While most LTCFs don't require contact precautions for MRSA-infected or colonized patients, the VA, which launched a MRSA prevention initiative in 2007, has taken a more aggressive approach. From 2008 to 2013, the VA recommended contact precautions in LTCF patients who could not perform self-hygiene, then in 2013 extended that recommendation to all LTCF patients, while allowing for flexibility in implementation at a local level.
No impact on MRSA acquisition, infection rates
To investigate whether gown and glove use is having an impact on MRSA acquisition and infection at VA LTCFs, researchers with the University of Maryland Baltimore, University of Iowa, the VA Maryland Healthcare System, and the Iowa City VA Healthcare System looked at patient data from the 2 years before and after the more aggressive contact precautions policy was implemented. All VA LTCF patients who had a negative MRSA culture on admission and at least one additional culture collected were included. The primary outcome was MRSA acquisition.
Of 75,414 patient admissions at 74 LTCFs from 2011 through 2015, 30,247 were at facilities using standard precautions and 45,167 were at facilities using contact precautions. The rate of MRSA acquisition was 2.55 per 1,000 patient-days in the standard precautions LTCFs vs 2.54 per 1,000 patient-days in the contact precautions LTCFs. After adjusting for patient demographics, risk factors, and years of admission, the researchers found no difference in MRSA acquisition between facilities that use contact precautions and those that use standard precautions (odds ratio [OR], 0.97; 95% confidence interval [CI] 0.85 to 1.12, P = 0.71).
The researchers also found that during the study period, the rates of MRSA HAIs declined by 8% across all LTCFs each year, falling from 0.19 per 1,000 bed-days in 2011 to 0.13 per 1,000 bed-days in 2015. But the rates were no different between residents on standard precautions vs those on contact precautions (rate ratio, 1.13; 95% CI 0.74 to 1.72, P = 0.58).
The factors that were associated with MRSA acquisition included colonization pressure (the proportion of residents in a facility with MRSA), admission from acute care, and the presence of a pressure ulcer.
The researchers suggest that the use of gloves and gowns may not have an impact on MRSA acquisition or MRSA HAI rates in LTCFs because patients are often outside of their rooms, in common areas where contact precautions are not practiced. They theorize that the decline of MRSA HAIs across all facilities could be linked to other aspects of the VA's MRSA prevention initiative, which includes increased resources for infection control, improved hand hygiene, and standardized HAI reporting.
The researchers also suggest that while widespread use of contact precautions does not have an impact on MRSA acquisition, a more targeted approach is worth exploring.
"The lack of association between widespread use of contact precautions for MRSA and MRSA acquisition does not mean that more targeted approaches to use gowns and gloves would not impact acquisition," they write. "Other targeted approaches may include focusing on highest risk activities or residents for use of gowns and gloves."
See also:
Oct 22 Clin Infect Dis abstract
