The effectiveness of Contact Precautions on methicillin-resistant Staphylococcus aureus (MRSA) in long-term care across the United States.

BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of healthcare-associated infections in long-term care facilities (LTCF). The Centers for Disease Control and Prevention (CDC) recommends Contact Precautions for prevention of MRSA within acute care facilities and are being used within the United States Department of Veterans Affairs (VA) for LTCF in a modified fashion. The impact of Contact Precautions in long-term care is unknown. METHODS To evaluate if Contact Precautions decreased MRSA acquisition in LTCF compared to Standard Precautions we performed a retrospective effectiveness study (pre-post with concurrent controls) using data from the VA healthcare system from 1/1/2011 until 12/31/2015, two years before and after a 2013 policy recommending a more aggressive form of Contact Precautions. RESULTS Across 75,414 patient admissions from 74 long-term care facilities in the United States, the overall unadjusted rate of MRSA acquisition was 2.6/1000 patient days. Patients were no more likely to acquire MRSA if they were cared for using Standard Precautions vs. Contact Precautions in multivariable discrete-time survival analysis, controlling for patient demographics, risk factors, and year of admission (Odds Ratio (OR) 0.97, 95% confidence interval (CI), 0.85-1.12, p=0.71). CONCLUSIONS MRSA acquisition and infections were not impacted by use of active surveillance and Contact Precautions in LTCF in the VA.