Research Prompts Banner Health to Change Protocol for Contact Precautions for Common Bacterial Infections

Research by Kristen Young, DO, chief resident and junior faculty in the Internal Medicine Residency at the University of Arizona College of Medicine – Phoenix, has prompted all 28 Banner Health hospitals to discontinue contact precautions for historical MRSA.

Dr. Young examined the use of contact precautions by health care providers for common bacterial infections that include methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE).

Her research, published in the March Journal of Hospital Medicine, the official peer-reviewed journal of the Society of Hospital Medicine, was titled “Things We Do for No Reason: Contact Precautions (CP) for MRSA and VRE.”

Contact precautions are typically used for patients with harmful bacteria that could potentially spread, so patients are put in isolation, based on the theory that it could prevent the spread of bacteria. Dr. Young’s review revealed that for MRSA and VRE, CP does not effectively reduce transmission of these bacteria and by eliminating these protocols, it could improve the quality of patient care and save hospital spending.

“CP is a seemingly benign intervention, but the data demonstrates that this is a low-value intervention with real patient safety concerns,” Dr. Young said. “It's important that we recognize that there are inherent safety concerns related to them, work to decrease the use to only when there is a clear benefit and quickly remove them as we are able.”

In response to the emerging evidence on contact precautions and Dr. Young’s research within the Banner system, in October 2017, Banner Health discontinued Contact Precautions for historical MRSA, partially changing their policy to reflect the evidence presented in her manuscript. Her efforts resulted in winning the UA College of Medicine – Phoenix Graduate Medical Education High Value Idea Competition in May 2017.

“CP is associated with increased falls, pressure ulcers, increased hospital-associated anxiety and depression, and delays at admission and discharge,” Dr. Young said. “CP is also associated with increased length of stay, higher costs of care and readmission rates. We expect to make a difference in all of these by appropriately discontinuing CP where able.” 

Dr. Young became interested in this area of research because of her uncle, who is routinely placed on contact precautions when he is admitted to the hospital. As a family member, she watched as he experienced many of the adverse events, which she described in her paper. Two years ago, she read an article from researchers at the University of California Los Angeles that demonstrated no change in MRSA transmission after discontinuing CP and a cost savings of about $4 million.

“Hospitals should evaluate their use of contact precautions policies, and if they have low endemic rates of MRSA and VRE and high hand hygiene rates, they should discontinue routine use of contact precautions for patients with MRSA and VRE,” Dr. Young said. “Patients and families are often distressed when they are put on contact precautions, and if it is for an unnecessary reason, hospitals should work to remove them to prevent all of the safety concerns that go with CP.”