title: Impact of contact precautions on falls, pressure ulcers  and transmission of MRSA and VRE in hospitalized  patients.
abstract: BACKGROUND
  Hospitals use contact precautions to prevent the spread of meticillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). There is concern that contact precautions may have adverse effects on the safety of isolated patients. In November 2010, the infection control policy at an academic medical centre was modified, and contact precautions were discontinued for patients colonized or infected with MRSA or VRE (MRSA/VRE patients).
  
  
  OBJECTIVE
  To assess the rates of falls and pressure ulcers among MRSA/VRE patients and other adult medical-surgical patients, as well as changes in MRSA and VRE transmission before and after the policy change.
  
  
  METHODS
  A single-centre retrospective hospital-wide cohort study was performed from 1st November 2009 to 31st October 2011.
  
  
  RESULTS
  Rates of falls and pressure ulcers were significantly higher among MRSA/VRE patients compared with other adult medical-surgical patients before the policy change (falls: 4.57 vs 2.04 per 1000 patient-days, P < 0.0001; pressure ulcers: 4.87 vs 1.22 per 1000 patient-days, P < 0.0001) and after the policy change (falls: 4.82 vs 2.10 per 1000 patient-days, P < 0.0001; pressure ulcers: 4.17 vs 1.19 per 1000 patient-days, P < 0.0001). No significant differences in the rates of falls and pressure ulcers among MRSA/VRE patients were found after the policy change compared with before the policy change. There was no overall change in MRSA or VRE hospital-acquired transmission.
  
  
  CONCLUSIONS
  MRSA/VRE patients had higher rates of falls and pressure ulcers compared with other adult medical-surgical patients. Rates were not affected by removal of contact precautions, suggesting that other factors contribute to these complications. Further research is required among this population to prevent complications.
authors.affiliation: Center for Disease Dynamics, Economics and Policy, 1616 P Street NW, Suite 430, Washington, DC 20036, USA. gandra@cddep.org
authors.forename: S
authors.initials: S
authors.lastname: Gandra
authors.forename: C M
authors.initials: CM
authors.lastname: Barysauskas
authors.forename: D A
authors.initials: DA
authors.lastname: Mack
authors.forename: B
authors.initials: B
authors.lastname: Barton
authors.forename: R
authors.initials: R
authors.lastname: Finberg
authors.forename: R T
authors.initials: RT
authors.lastname: Ellison
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D006761:Hospitals; D006801:Humans; D017053:Infection Control; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000254:growth & development / Q000302:isolation & purification; D008875:Middle Aged; D010356:Patient Isolation; D003668:Pressure Ulcer / Q000453:epidemiology*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission; D065507:Vancomycin-Resistant Enterococci / Q000254:growth & development / Q000302:isolation & purification