From the 2019 HVPAA National Conference
Dr. Kristen Young (University of Arizona College of Medicine – Phoenix), Dr. Ruth Franks-Snedecor (University of Arizona College of Medicine – Phoenix), Dr. Emily Mallin (University of Arizona College of Medicine – Phoenix)
The use of contact precautions (CP) for patients with colonized or infected (endemic) methicillin-resistant Staphylococcus aureus (MRSA) is common in many hospitals, but emerging literature does not support CP over standard precautions in preventing hospital acquired MRSA. CP is associated with delays in admission and discharge, fewer bedside evaluations, preventable adverse events such as falls and pressure ulcers. CP is linked with hospital-associated depression and anxiety and decreased patient and provider satisfaction. Given the lack of proven benefit and potential harms, many hospitals have reevaluated their policies related to CP. In our previously presented abstract, we demonstrated no change in hospital acquired MRSA after elimination of CP for historical MRSA in two community hospitals within our system, along with demonstrating residents spend less time with patients on CP and visit patients less often. With this knowledge, we explored the cost and value of CP for endemic MRSA.
To measure the cost of eliminating contact precautions for endemic MRSA at our academic medical center, in order to understand the negative impact of this common practice.
We used electronic health record admission data and ICD-10 codes containing “methicillin-resistant Staphylococcus aureus” to determine the total number of patients on CP for endemic MRSA within academic medical center for the year 2016. For this set of patients, we determined their length of stay. Using available literature (Tran, et al. 2017), we utilized the published 30% increase in length of stay for patients on CP for endemic MRSA. We observed contact precaution rooms to develop our time based costing for nursing time. We used supply cost data to determine the material cost of gowns, gloves, and disposable stethoscopes.
While initially evaluating the value of contact precautions for endemic MRSA, we calculate the waste related to endemic CP for MRSA at our academic, tertiary medical center (Table 1). In 2016, we had 386 patients on contact precautions for MRSA identified in our EMR with an average length of stay of 13.3 days. Adjusting this population for a 30% increase length in stay and using our system’s cost of length of stay day, we calculated the waste related to increase LOS, $1,158,000, for one year. We calculated cost of supplies for one year at $40,000. Using time-based costing of health care worker time using data from nursing observation we calculated $523,648, or 6,982 hours wasted by donning contact precautions each year for endemic MRSA. The total waste related to CP calculated was $1,721,648 for one year at an academic medical center.
This data adds to the growing evidence that contact precautions add to health care waste, particularly when accounting for increase length of stay, heath care worker time, and supply costs, without proven benefit for patients.
Revaluating the routine use of contact precautions has significant clinical implications for hospital systems, both directly impacting patient safety and cost of care. In our own system, this work led to a change in policy throughout our 28-hospital systems, and contact precautions for historical MRSA were eliminated in October 2017.