Incidence of HAI ESBL patients before and after

Incidence of HAI ESBL + patients before and after discontinuation of contact precautions American Journal of Infection Control 48 (2020) 52− 55 (January 2020) Incidence of health care−associated extended-spectrum b-lactamase positive patients before and after discontinuation of contact precautions Peggy Thompson RN, BSN, CIC, FAPIC *, Jonathan Teter MS, CIC, NREMT, Kimberly Atrubin MPH, CIC, CPHQ By Regina Livshits, RN, MCN, CIC, ONC, IIWCC, NYU Langone Health, Infection Prevention & Control Dept.

Incidence of HAI ESBL + patients • Extended-spectrum beta-lactamases (ESBL) are enzymes that confer resistance to most beta-lactam antibiotics, including penicillins, cephalosporins, and the monobactam aztreonam. • Community transmission: • Meat • Food sources

Incidence of HAI ESBL + patients • Barriers for patients on Contact Precautions: * adverse outcomes – falls, pressure ulcers, electrolyte errors • * providers will not assess patient as many times as needed * negative impact on mental well being – depression, anger, anxiety Goal of the Study: to review the incidence of HAI and colonization of patients with ESBLproducing organisms both before and after discontinuing the use of Contact Precautions. 1010 bed, non profit academic center Preintervention period: January, 2014 – November 2015 Postintervention: December 2015 – August 2017 Both Community associated and HAI associated (on or after hospital day 3) were included in the review

Incidence of HAI ESBL + patients • Methods: • Remove Contact Precautions on colonized or infected patients • No changes made for MDRO policy • Surgical site infections are excluded Results: 1273 laboratory tests: 387 – HAIs ESBL for 3 year period (01/2014 -08/17) No increase in the incidence after discontinuation of routine Contact Precautions.

Incidence of HAI ESBL + patients • Prediscontinuation period: • Incidence density 3. 71 per 10, 000 patient days • Postintervention period: • 3. 0 per 10, 000 patient days • Community acquired: 13. 11 per 10, 000 to 17. 20

Incidence of HAI ESBL + patients • Discussions: • No increase in incidence of HAI ESBL producing incidence after discontinuation of routine Contact Precautions • Overall decrease rate HAI ESBL • Transmission occurs in the community • No increase risk of transmission when routine Contact Precautions were not used • Limitations: * no screening for colonization on admission * no review of comorbidities * ESBL E. coli vs other ESBL producing organisms * no genetic typing performed