Impact of Discontinuing Contact Precautions for MRSA and ESBLE in an Intensive Care Unit: A Prospective Noninferiority Before and After Study

Abstract

OBJECTIVE To compare incidence densities of methicillin-resistant Staphylococcus aureus (MRSA) or extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBLE) acquisition in the intensive care unit (ICU) before and after discontinuation of contact precautions (CP) and application of standard precautions (SP). DESIGN Prospective noninferiority before-and-after study comparing 2 periods: January 1, 2012, to January 31, 2014 (the CP period) and February 1, 2014, to February 29, 2016 (the SP period). SETTING A 16-bed polyvalent ICU in France with only single-bed rooms with dedicated equipment and reusable medical devices. PATIENTS All patients admitted to the ICU during the CP and SP periods were included: 1,547 and 1,577 patients, respectively. METHODS Incidence densities of ICU-acquired MRSA or ESBLE were determined per 1,000 patient days. Other studied factors included (1) patient characteristics, (2) incidence densities of MRSA or ESBLE carried at admission, (3) compliance with hand hygiene protocols, and (4) antibiotic consumption. RESULTS Incidence densities of ICU-acquired MRSA were 0.82 (95% confidence interval [CI], 0.31-1.33) and 0.79 (95% CI, 0.30-1.29) per 1,000 patient days during the CP and SP periods, respectively. For ESBLE, values were 2.7 (95% CI, 1.78-3.62) and 2.06 (95% CI, 1.27-2.86) per 1,000 patient days. These rates were significantly nonsuperior during the SP period compared to CP period, with a margin of 1 per 1,000 patient days for both MRSA (P=.002) and ESBLE (P=.004). Other factors were comparable during the 2 periods. Only ESBLE carried at admission was inferior during the SP period. We observed a high level of compliance to hand hygiene protocols. CONCLUSIONS Discontinuing CP did not increase acquired MRSA and ESBLE in our ICU with single rooms with dedicated equipment, strict application of hand hygiene, medical and paramedical leadership, and good antibiotic stewardship. Infect Control Hosp Epidemiol 2017;38:1342-1350.