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Elimination of contact precautions: effect on methicillin-resistant staphylococcus aureus outcomes

Latham, Keely (2018) Elimination of contact precautions: effect on methicillin-resistant staphylococcus aureus outcomes. Master Essay, University of Pittsburgh.

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Abstract

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is bacteria that is resistant to numerous commonly prescribed antibiotics, making it difficult to treat. MRSA can cause a variety of issues including skin infections, pneumonia, sepsis, or death. Contact Precautions (CPs) involving isolation are implemented within hospitals and other healthcare facilities to lessen the spread of MRSA. Recent research has suggested that CPs are unfavorable and should be replaced with universal precautions. As MRSA is a widely encountered problem in health care settings, it is important to expand this research. The objective of this project was to determine changes in MRSA conversion rates before and after CPs were altered at UPMC Mercy, a 495-bed academic facility, in February of 2018. The review included data from 2015 to September of 2018. Other objectives were to determine incidence of positive MRSA screens and incidence of bacteremia in those patients that converted.
Methods: UPMC Mercy patient data were collected through electronic medical records. These were accessed and used to determine converted patients, which were considered to be those who had an initial negative MRSA screen and then a later positive screen within the span of a year. This process was completed for 2015, 2016, 2017, and part of 2018. Conversion rates were determined for each year and compared using a chi-square analysis to detect any significant difference in rates before and after the change of CPs. Incidence of positive MRSA screens and incidence of bacteremia in converters was also compared using chi-square analyses to identify any significant changes before and after CPs were altered. Burden of bacteremia in converters was calculated and compared to burden in non-converter screen positive patients.
Results: Conversion rates were found to be 2.5%, 3.1%, 2.6%, and 2.6% for 2015, 2016, 2017, and 2018 respectively. Cumulative incidence of positive MRSA screens out of all screens was found to be 7.4%, 6.8%, 7.3%, and 7.3% for 2015 through 2018 respectively. Cumulative incidence of bacteremia in converters was found to be 8.8%, 7.4%, 7.1%, and 6.9% for 2015, 2016, 2017, and 2018 respectively. We found no significant differences in conversion rates before and after the change in CPs (p = 0.77). Also, no significant difference was found in incidence of positive MRSA screens before and after the change (p = 0.82) or incidence of bacteremia in converters (p = 0.87). Distribution of burden of bacteremia in converters and non-converters after the change appeared consistent with previous years, as rates in converters were 22.2%, 71.4%, 25.0%, 17.7% of all bacteremia annually from 2015 through 2018, with 2016 being the only anomaly.
Conclusion: The results indicate that the shift from CPs to universal precautions at UPMC Mercy did not significantly affect incidence of positive MRSA screens, incidence of bacteremia among converters, conversion rates, or burden of bacteremia between converters and non-converters. These findings suggest that CPs, which many hospitals around the United States still utilize, are unnecessary and ineffective. This work could lead to widespread changes in CPs in order to address the significant public health risk and economic burden of MRSA in the United States.


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Details

Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Latham, Keelykel130@pitt.edukel130
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairGlynn, Nancyglynnn@edc.pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberYassin, Mohamedyassinm@upmc.eduUNSPECIFIEDUNSPECIFIED
Committee MemberMartinson, Jeremyjmartins@pitt.eduUNSPECIFIEDUNSPECIFIED
Date: 13 December 2018
Date Type: Submission
Number of Pages: 37
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 28 Sep 2019 19:57
Last Modified: 28 Sep 2019 19:57
URI: http://d-scholarship.pitt.edu/id/eprint/35672

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