The 2007 Centers for Disease Control and Infection (CDC) Guideline on Preventing Transmission of Infectious Agents in Healthcare Settings emphasized contact precautions as a key strategy to reduce transmission of multidrug resistant organisms (MDROs). To ensure that contact precautions are initiated at hospitalization, a flag is automatically generated in the electronic medical record (EMR) for patients positive for selected MDROs. The majority of these flags are for Methicillin resistant staphylococcus aureus (MRSA) and Vancomycin resistant enterococci (VRE). Recently the value of isolation for endemic MRSA and VRE has been questioned and some institutions have discontinued contact precautions for these organisms. Many states still have laws that mandate active surveillance and isolation for MRSA. To decrease burden of unnecessary isolation, Infection Prevention and Control (IPAC) implemented a process to review and manage the isolation flag in the EMR.

A process for flag removal was outlined in 2012. IPAC called the medical team on select patients and recommended testing to facilitate flag removal. The process was time intensive and recommendations were not followed consistently. Quality improvement tools, including value stream mapping and time studies were used to identify improvement opportunities. This resulted in creation of a nursing protocol released in tandem with the new EMR in May 2018. The protocol allowed infection preventionists to place an order for repeat testing for MRSA/VRE on eligible patients.

Protocol use enabled IPAC to test and remove 604 MRSA and/or VRE flags between May 2018 and November 2019. Prior to initiation of the protocol, IPAC removed approximately 60 flags annually.

The EMR and nursing protocols can be leveraged to identify patients who no longer need contact precautions. This reduces the burden of isolation in hospitals that are not yet ready to eliminate contact precautions for MRSA and VRE.