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2019 HSR&D/QUERI National Conference Abstract

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4072 — The comparative effectiveness of isolation on methicillin-resistant Staphylococcus aureus (MRSA) in long-term care across a national system.

Lead/Presenter: DANIEL MORGAN
All Authors: Morgan DJ (Baltimore VA Medical Center, University of Maryland School of Medicine), Zhan M (VA Maryland Health Care System, Baltimore; University of Maryland Department of Epidemiology and Public Health, Division of Genomic Epidemiology and Clinical Outcomes Goto M (Department of Internal Medicine, Division of Infectious Diseases, University of Iowa Roy J. and Lucille A. Carver College of Medicine; Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), , Iowa City VA Health Care System) Franciscus C ( Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System) Alexander B (Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System) Vaughan-Sarrazin M (Department of Internal Medicine, Division of Infectious Diseases, University of Iowa Roy J. and Lucille A. Carver College of Medicine; Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine) Roghmann M (VA Maryland Health Care System, Baltimore; University of Maryland Department of Epidemiology and Public Health, Division of Genomic Epidemiology and Clinical Outcomes) Pineles L (VA Maryland Health Care System, Baltimore; University of Maryland Department of Epidemiology and Public Health, Division of Genomic Epidemiology and Clinical Outcomes)

Objectives:
To evaluate if isolation decreased Methicillin-resistant Staphylococcus aureus (MRSA) acquisition in long-term care facilities (LTCF) compared to standard precautions

Methods:
We performed a pragmatic comparative effectiveness study of MRSA isolation practice across VA LTCF. Measurements included acquisition of MRSA and facility-level CDC defined MRSA healthcare-associated infections (HAIs). Residents admitted to VA LTCF from 1/1/2011 until 12/31/2015 were identified through the Minimum Data Set. The primary outcome from VA CDW was any positive culture or PCR test for MRSA indicating acquisition of MRSA in a patient previously negative for MRSA. For the secondary outcome, data on combined facility-level MRSA infection rates were obtained from the VA Inpatient Evaluation Center. We applied GEE with Poisson distribution and a logarithm link function to examine the associations of the facility level MRSA prevention policy with the facility level rate of MRSA acquisitions.

Results:
Patients were no more likely to acquire MRSA if they were cared for using isolation vs. standard precautions in multivariable discrete-time survival analysis, controlling for patient demographics, risk factors, and year of admission (Odds Ratio (OR) 0.97, 95 percent confidence interval (CI), 0.85-1.12, p = 0.71). Residents were more likely to acquire MRSA in facilities with higher colonization pressure (OR 1.24 to OR 1.92 in the highest quartile of colonization pressure. Overall, rates of MRSA HAIs declined by 30 percent (0.19 per 1000 bed-days in 2011 vs. 0.13 per 1000 bed-days in 2015, P = 0.01), but there were no differences between residents on isolation vs. standard precautions (Relative rate ratio isolation vs standard 1.13, 95 percent CI: 0.74, 1.72, P = 0.58 multivariable Poisson regression).

Implications:
Rates of MRSA HAIs have declined in VA LTCF but MRSA acquisition and HAIs were similar in facilities with variable isolation policies. Isolation for MRSA is low-value in LTCF.

Impacts:
Patients at high risk of MRSA acquisition include those with pressure ulcers and high dependency, comorbidities or facilities with high colonization pressure. Resources for infection control should be allocated to evidence-based interventions.