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The Impact of Isolation on Healthcare Worker Contact and Compliance With Infection Control Practices in Nursing Homes

  • Lisa Pineles (a1), Chris Petruccelli (a1), Eli N. Perencevich (a2), Mary-Claire Roghmann (a1), Kalpana Gupta (a3), Jose Cadena (a4), Gio Baracco (a5), Christopher D. Pfeiffer (a6) (a7), Graeme Forrest (a6) (a7), Suzanne F. Bradley (a8), Chris Crnich (a9), Heather Reisinger (a2) and Daniel J. Morgan (a1)...

Abstract

OBJECTIVE

To directly observe healthcare workers in a nursing home setting to measure frequency and duration of resident contact and infection prevention behavior as a factor of isolation practice

DESIGN

Observational study

SETTING AND PARTICIPANTS

Healthcare workers in 8 VA nursing homes in Florida, Maryland, Massachusetts, Michigan, Washington, and Texas

METHODS

Over a 15-month period, trained research staff without clinical responsibilities on the units observed nursing home resident room activity for 15–30-minute intervals. Observers recorded time of entry and exit, isolation status, visitor type (staff, visitor, etc), hand hygiene, use of gloves and gowns, and activities performed in the room when visible.

RESULTS

A total of 999 hours of observation were conducted across 8 VA nursing homes during which 4,325 visits were observed. Residents in isolation received an average of 4.73 visits per hour of observation compared with 4.21 for nonisolation residents (P<.01), a 12.4% increase in visits for residents in isolation. Residents in isolation received an average of 3.53 resident care activities per hour of observation, compared with 2.46 for residents not in isolation (P<.01). For residents in isolation, compliance was 34% for gowns and 58% for gloves. Healthcare worker hand hygiene compliance was 45% versus 44% (P=.79) on entry and 66% versus 55% (P<.01) on exit for isolation and nonisolation rooms, respectively.

CONCLUSIONS

Healthcare workers visited residents in isolation more frequently, likely because they required greater assistance. Compliance with gowns and gloves for isolation was limited in the nursing home setting. Adherence to hand hygiene also was less than optimal, regardless of isolation status of residents.

Infect Control Hosp Epidemiol 2018;39:683–687

Copyright

Corresponding author

Address correspondence to Lisa Pineles, MA, 10 S Pine St, MSTF 360B, Baltimore, MD 21201 (lpineles@som.umaryland.edu).

References

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1. Montoya, A, Mody, L. Common infections in nursing homes: a review of current issues and challenges. Aging Health 2011;7:889899.
2. Strausbaugh, LJ, Joseph, CL. The burden of infection in long-term care. Infect Control Hosp Epidemiol 2000;21:674679.
3. Cassone, M, Mody, L. Colonization with multi-drug resistant organisms in nursing homes: scope, importance, and management. Curr Geriatr Rep 2015;4:8795.
4. Dantes, R, Mu, Y, Belflower, R, et al. National burden of invasive methicillin-resistant Staphylococcus aureus infections, United States, 2011. JAMA Intern Med 2013;173:19701978.
5. Herzig, CTA, Dick, AW, Sorbero, M, et al. Infection trends in US nursing homes, 2006–2013. J Am Med Dir Assoc 2017;18:635.e9635.e20.
6. Evans, ME, Kralovic, SM, Simbartl, LA, et al. Nationwide reduction of health care-associated methicillin-resistant Staphylococcus aureus infections in Veterans Affairs long-term care facilities. Am J Infect Control 2014;42:6062.
7. Stone, ND, Lewis, DR, Johnson, TM 2nd, et al. Methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage in residents of Veterans Affairs long-term care facilities: role of antimicrobial exposure and MRSA acquisition. Infect Control Hosp Epidemiol 2012;33:551557.
8. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L, Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings. Am J Infect Control 2007;35(10 Suppl 2):S165S193.
9. Morgan, DJ, Diekema, DJ, Sepkowitz, K, Perencevich, EN. Adverse outcomes associated with contact precautions: a review of the literature. Am J Infect Control 2009;37:8593.
10. Morgan, DJ, Wenzel, RP, Bearman, G. Contact precautions for endemic MRSA and VRE: time to retire legal mandates. JAMA 2017;318:329330.
11. Furuno, JP, Krein, S, Lansing, B, Mody, L. Health care worker opinions on use of isolation precautions in long-term care facilities. Am J Infect Control 2012;40:263266.
12. Cohen, CC, Dick, A, Stone, PW. Isolation precautions use for multidrug-resistant organism infection in nursing homes. J Am Geriatr Soc 2017;65:483489.
13. Dumyati, G, Stone, ND, Nace, DA, Crnich, CJ, Jump, RL. Challenges and strategies for prevention of multidrug-resistant organism transmission in nursing homes. Curr Infect Dis Rep 2017;19 18-017-0576-7.
14. Tsan, L, Langberg, R, Davis, C, et al. Nursing home-associated infections in Department of Veterans Affairs community living centers. Am J Infect Control 2010;38:461466.
15. Department of Veterans Affairs. Revised guideline for implementation of the VHA MRSA prevention initiative in community living centers. Unpublished internal document, 2013.
16. Ye, Z, Mukamel, DB, Huang, SS, Li, Y, Temkin-Greener, H. Healthcare-associated pathogens and nursing home policies and practices: results from a national survey. Infect Control Hosp Epidemiol 2015;36:759766.
17. Chang, NC, Reisinger, HS, Jesson, AR, et al. Feasibility of monitoring compliance to the My 5 Moments and Entry/Exit hand hygiene methods in US hospitals. Am J Infect Control 2016;44:938940.
18. Harris, AD, Pineles, L, Belton, B, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA 2013;310:15711580.
19. Morgan, DJ, Pineles, L, Shardell, M, et al. The effect of contact precautions on healthcare worker activity in acute care hospitals. Infect Control Hosp Epidemiol 2013;34:6973.
20. Dhar, S, Marchaim, D, Tansek, R, et al. Contact precautions: more is not necessarily better. Infect Control Hosp Epidemiol 2014;35:213221.
21. Anderson, DJ, Weber, DJ, Sickbert-Bennett, E. On contact precautions: the good, the bad, and the ugly. Infect Control Hosp Epidemiol 2014;35:222224.
22. Schweon, SJ, Edmonds, SL, Kirk, J, Rowland, DY, Acosta, C. Effectiveness of a comprehensive hand hygiene program for reduction of infection rates in a long-term care facility. Am J Infect Control 2013;41:3944.
23. Thompson, BL, Dwyer, DM, Ussery, XT, Denman, S, Vacek, P, Schwartz, B. Handwashing and glove use in a long-term-care facility. Infect Control Hosp Epidemiol 1997;18:97103.
24. Mody, L. Infection control issues in older adults. Clin Geriatr Med 2007;23:499514, vi.
25. Almaguer-Leyva, M, Mendoza-Flores, L, Medina-Torres, AG, et al. Hand hygiene compliance in patients under contact precautions and in the general hospital population. Am J Infect Control 2013;41:976978.
26. Department of Veterans Affairs. Guidelines for standard and transmission-based precautions (formerly isolation). Unpublished internal document, 2016.

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