Active Surveillance and Contact Precautions for Preventing Methicillin-Resistant Staphylococcus aureus Healthcare-Associated Infections during the COVID-19 Pandemic.

Evans ME, Simbartl LA, McCauley BP, Flarida LK, Jones MM, Harris AD, Perencevich EN, Rubin MA, Hicks NR, Kralovic SM, Roselle GA. Active Surveillance and Contact Precautions for Preventing Methicillin-Resistant Staphylococcus aureus Healthcare-Associated Infections during the COVID-19 Pandemic. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2023 Jun 30.

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Abstract:

BACKGROUND: Statistically significant decreases in methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infections (HAIs) occurred in Veterans Affairs (VA) hospitals from 2007-2019 using a national policy of active surveillance (AS) for facility admissions and contact precautions for MRSA colonized (CPC) or infected (CPI) patients, but the impact of suspending these measures to free up laboratory resources for testing and conserve personal protective equipment for COVID-19 on MRSA HAI rates is not known. METHODS: From July 2020 - June 2022 all 123 acute care VA hospitals nationwide were given the rolling option to suspend (or re-initiate) any combination of AS, CPC, or CPI each month, and MRSA HAIs in intensive care units (ICUs) and non-ICUs were tracked. RESULTS: There were 917,591 admissions, 5,225,174 patient-days, and 568 MRSA HAIs. The MRSA HAI rate/1,000 patient-days in ICUs was 0.20 (95% CI, 0.15-0.26) for facilities practicing "AS + CPC + CPI" compared to 0.65 (95% CI, 0.41-0.98; P < .001) for those not practicing any of these strategies, and in non-ICUs was 0.07 (95% CI, 0.05-0.08) and 0.12 (95% CI, 0.08-0.19; P = .01) for the respective policies. Accounting for monthly COVID-19 facility admissions using a negative binomial regression model did not change the relationships between facility policy and MRSA HAI rates. There was no significant difference in monthly facility urinary catheter-associated infection rates, a non-equivalent dependent variable, in the policy categories in either ICUs or non-ICUs. CONCLUSIONS: Facility removal of MRSA prevention practices was associated with higher rates of MRSA HAIs in ICUs and non-ICUs.