Does the removal of Contact precautions for MRSA and VRE Infected Patients Change Healthcare-associated Infection Rate?: A systematic review and meta-analysis.

Kleyman, Robert; Cupril-Nilson, Sophia; Robinson, Kent; Thakore, Shaival; Haq, Furqan; Chen, Liwei; Oyesanmi, Olu; Browning, Kimberly; Pino, Joseph; Mhaskar, Rahul

OBJECTIVE Update existing meta-analysis to analyze if discontinuation of contact precautions (CPs) for Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin resistant Enterococcus (VRE) colonization or infection affects hospital-associated MRSA or VRE infection rates. METHODS We conducted a systematic review of 17 studies evaluating discontinuation of CPs for MRSA and VRE. Random-effects and fixed-effects models were used to determine the pooled risk ratios of pre incidence hospital-associated infection rate to post incidence rate. Subgroup analysis was used to assess sources of heterogeneity. RESULTS No significant difference between rates of hospital-associated MRSA infection before and after stopping the CPs was observed (RR, 0.84; 95% CI, 0.71 - 1.01; p = 0.06). An inverse association was observed between discontinuation of CPs and rates of hospital-associated VRE infection (RR, 0.82; 95% CI, 0.72 - 0.94; p =0.005). A subgroup analysis of six studies that used chlorhexidine, showed no difference between rates of hospital-associated MRSA infection with discontinuation of CPs (RR, 0.83; 95% CI, 0.69 - 1.00; p = 0.05). In five studies that did not use chlorhexidine, there was no difference between rates of hospital-associated MRSA infection with discontinuation of CPs (RR, 1.02; 95% CI, 0.55 - 1.88; p = 0.95). CONCLUSIONS There was no significant difference in rates of hospital-associated MRSA infection before and after removing CPs. Additionally, there were decreased rates of hospital-associated VRE infection following stoppage of CPs.