Association of hospital contact precaution policies with emergency department admission time
Department of Emergency Medicine; Department of Microbiology and Physiological Systems; Department of Quantitative Health Sciences; Department of Infection Control, UMass Memorial Medical Center; Department of Medicine, Division of Infectious Diseases and Immunology
Emergency Medicine | Health and Medical Administration | Infectious Disease
BACKGROUND: Contact precautions are a widely accepted strategy to reduce in-hospital transmission of meticillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). However, these practices may have unintended deleterious effects on patients.
AIM: To evaluate the effect of a modification in hospital-wide contact precaution practices on emergency department (ED) admission times.
METHODS: During the study period, the hospital changed its contact precaution policy from requiring contact precautions for all patients with a history of MRSA or VRE to only those who presented with clinical conditions likely to contaminate the environment with pathogens. An interrupted time series analysis of ED admission times for adults for one year preceding and one year following this change was performed at a two-campus hospital. The main outcome was admission time, defined as time from decision to admit to arrival in an inpatient bed, for patients with MRSA or VRE compared with all other patients. The in-hospital MRSA and VRE acquisition rates were evaluated over the same period and have been published previously.
FINDINGS: At one campus, admission time decreased immediately by 161min for MRSA patients (P=0.008) and 135min for VRE patients (P=0.003), and both continued to decrease over the duration of the study. There was no significant change in admission time at the second campus.
CONCLUSIONS: Modifying contact precaution requirements for MRSA and VRE may be associated with improved ED admission time without significantly altering in-hospital MRSA and VRE acquisition.
Contact precautions, MRSA, VRE
DOI of Published Version
J Hosp Infect. 2017 Jul;96(3):244-249. doi: 10.1016/j.jhin.2017.03.023. Epub 2017 Mar 24. Link to article on publisher's site
The Journal of hospital infection
Kotkowski, Kevin A.; Ellison, Richard T. 3rd; Barysauskas, Constance; Barton, Bruce; Allison, Jeroan J.; Mack, DeborahAnn; Finberg, Robert W.; and Reznek, Martin A., "Association of hospital contact precaution policies with emergency department admission time" (2017). Emergency Medicine Publications and Presentations. 120.