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The Effect of Contact Precautions on Healthcare Worker Activity in Acute Care Hospitals

Published online by Cambridge University Press:  02 January 2015

Daniel J. Morgan ,
Lisa Pineles ,
Michelle Shardell ,
Margaret M. Graham ,
Shahrzad Mohammadi ,
Graeme N. Forrest ,
Heather S. Reisinger ,
Marin L. Schweizer  and
Eli Perencevich
Daniel J. Morgan*
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland Veterans Affairs Maryland Health Care System, Baltimore, Maryland
Lisa Pineles
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland Veterans Affairs Maryland Health Care System, Baltimore, Maryland
Michelle Shardell
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Margaret M. Graham
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa
Shahrzad Mohammadi
Affiliation:
Portland Veterans Affairs Medical Center, Portland, Oregon
Graeme N. Forrest
Affiliation:
Portland Veterans Affairs Medical Center, Portland, Oregon
Heather S. Reisinger
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Marin L. Schweizer
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa
Eli Perencevich
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
*
685 West Baltimore Street, MSTF 334D, Baltimore, MD 21201 (dmorgan@epi.umaryland.edu)
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Abstract

Background and Objective.

Contact precautions are a cornerstone of infection prevention but have also been associated with less healthcare worker (HCW) contact and adverse events. We studied how contact precautions modified HCW behavior in 4 acute care facilities.

Design.

Prospective cohort study.

Participants and Setting.

Four acute care facilities in the United States performing active surveillance for methicillin-resistant Staphylococcus aureus.

Methods.

Trained observers performed “secret shopper” monitoring of HCW activities during routine care, using a standardized collection tool and fixed 1-hour observation periods.

Results.

A total of 7,743 HCW visits were observed over 1,989 hours. Patients on contact precautions had 36.4% fewer hourly HCW visits than patients not on contact precautions (2.78 vs 4.37 visits per hour; P< .001 ) as well as 17.7% less direct patient contact time with HCWs (13.98 vs 16.98 minutes per hour; P = .02). Patients on contact precautions tended to have fewer visitors (23.6% fewer; P = .08). HCWs were more likely to perform hand hygiene on exiting the room of a patient on contact precautions (63.2% vs 47.4% in rooms of patients not on contact precautions; P< .001).

Conclusion.

Contact precautions were found to be associated with activities likely to reduce transmission of resistant pathogens, such as fewer visits and better hand hygiene at exit, while exposing patients on contact precautions to less HCW contact, less visitor contact, and potentially other unintended outcomes.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 1 , January 2013 , pp. 69 - 73
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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References

1. Klevens, RM, Edwards, JR, Richards, CL, et al. Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep 2007;122:160.10.1177/003335490712200205Google Scholar
2. Jain, R, Kralovic, SM, Evans, ME, et al. Veterans affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. NEngl J Med 2011;364:1419–1430, doi:10.1056/NEJMoa1007474.Google Scholar
3. Centers for Disease Control and Prevention. Vital signs: central line-associated blood stream infections-United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep 2011;60: 243–248.Google Scholar
4. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Health Care Infection Control Practices Advisory Committee. 2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35(Suppl 2):S65–S164, doi:10.1016/j.ajic.2007.10.007.Google Scholar
5. Morgan, DJ, Diekema, DJ, Sepkowitz, K, Perencevich, EN. Adverse outcomes associated with contact precautions: a review of the literature. Am J Infect Control 2009;37:85–93, doi:10.1016/j.ajic.2008.04.257.Google Scholar
6. Stelfox, HT, Bates, DW, Redelmeier, DA. Safety of patients isolated for infection control. JAMA 2003;290:1899–1905, doi:10.1001/ jama.290.14.1899.Google Scholar
7. Day, HR, Perencevich, EN, Harris, AD, et al. Association between contact precautions and delirium at a tertiary care center. Infect Control Hosp Epidemiol 2012;33:34–39, doi: 10.1086/663340.Google Scholar
8. Gasink, LB, Singer, K, Fishman, NO, et al. Contact isolation for infection control in hospitalized patients: is patient satisfaction affected? Infect Control Hosp Epidemiol 2008;29:275–278, doi: 10.1086/527508.Google Scholar
9. Morgan, DJ, Day, HR, Harris, AD, Furano, JP, Perencevich, EN. The impact of contact isolation on the quality of inpatient hospital care. PLoS One 2011;6:e22190, doi:10.1371/journal.pone.0022190.Google Scholar
10. Evans, HL, Shaffer, MM, Hughes, MG, et al. Contact isolation in surgical patients: a barrier to care? Surgery 2003;134:180–188, doi: 10.1067/msy.2003.222.Google Scholar
11. Kirkland, KB, Weinstein, JM. Adverse effects of contact isolation. Lancet 1999;354:1177–1178, doi:10.1016/S0140-6736(99)04196-3.Google Scholar
12. Trick, WE, Vernon, MO, Welbel, SF, et al. Multicenter intervention program to increase adherence to hand hygiene recommendations and glove use and to reduce the incidence of antimicrobial resistance. Infect Control Hosp Epidemiol 2007;28:42–49, doi: 10.1086/510809.Google Scholar
13. Fuller, C, Savage, J, Besser, S, et al. “The dirty hand in the latex glove”: a study of hand hygiene compliance when gloves are worn. Infect Control Hosp Epidemiol 2011;32:1194–1199, doi: 10.1086/662619.Google Scholar
14. Bearman, GM, Marra, AR, Sessler, CN, et al. A controlled trial of universal gloving versus contact precautions for preventing the transmission of multidrug-resistant organisms. Am J Infect Control 2007;35:650–655, doi:10.1016/j.ajic.2007.02.011.Google Scholar
15. Reisinger, HS, Vander Weg, M, Morgan, D, Forrest, G, Shardell, M, Perencevich, E. Improving hand-hygiene compliance with point-of-use reminder signs designed using theoretical grounded messages. In: IDWeek 2012. San Diego, CA: IDWeek, October 18, 2012.Google Scholar
16. Morgan, DJ, Pineles, L, Shardell, M, et al. Automated hand hygiene count devices may better measure compliance than human observation. Am J Infect Control 2012, http://www.ncbi.nlm.nih.gov/pubmed/19249637.10.1016/j.ajic.2012.01.026Google Scholar
17. Donner, A, Klar, N. Design and analysis of cluster randomization trials in health research. Int J Epidemiol 2001;30:407–408.Google Scholar
18. Saint, S, Higgins, LA, Nallamothu, BK, Chenoweth, C. Do physicians examine patients in contact isolation less frequentiy? a brief report. Am J Infect Control 2003;31:354–356.10.1016/S0196-6553(02)48250-8Google Scholar
19. Sales, A, Sharp, N, Li, YF, et al. The association between nursing factors and patient mortality in the Veterans Health Administration: the view from the nursing unit level. Med Care 2008; 46:938–945, doi: 10.1097/MLR.0b013e3181791a0a.Google Scholar
20. Gilbert, K, Stafford, C, Crosby, K, Fleming, E, Gaynes, R. Does hand hygiene compliance among health care workers change when patients are in contact precaution rooms in ICUs? Am J Infect Control 2010;38:515–517, doi:10.1016/j.ajic.2009.11.005.Google Scholar