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Contact Precautions More Is Not Necessarily Better

Published online by Cambridge University Press:  10 May 2016

Sorabh Dhar*
Detroit Medical Center, Wayne State University, Detroit, Michigan John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
Dror Marchaim
Assaf Harofeh Medical Center, Zerifin, Israel, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Ryan Tansek
George Washington University Hospital, Washington, DC
Teena Chopra
Detroit Medical Center, Wayne State University, Detroit, Michigan
Adnan Yousuf
Louis A. Wells Memorial Hospital, Chicago, Illinois
Ashish Bhargava
Detroit Medical Center, Wayne State University, Detroit, Michigan
Emily T. Martin
Detroit Medical Center, Wayne State University, Detroit, Michigan
Thomas R. Talbot
Vanderbilt University School of Medicine, Nashville, Tennessee
Laura E. Johnson
Henry Ford Health System, Detroit, Michigan
Ameet Hingwe
Baptist Medical Center, Jacksonville, Florida
Jerry M. Zuckerman
Albert Einstein Medical Center, Philadelphia, Pennsylvania
Bartholomew R. Bono
Bryn Mawr Hospital, Philadelphia, Pennsylvania
Emily K. Shuman
University of Michigan, Ann Arbor, Michigan
Jose Poblete
Summa Health Care System, Akron, Ohio
MaryAnn Tran
Michigan State University, East Lansing, Michigan
Grace Kulhanek
Michigan State University, East Lansing, Michigan
Rama Thyagarajan
Oakwood Health Care System, Dearborn, Michigan
Vijayalakshmi Nagappan
Oakwood Health Care System, Dearborn, Michigan
Carrie Herzke
Johns Hopkins Medical Institutions, Baltimore, Maryland
Trish M. Perl
Johns Hopkins Medical Institutions, Baltimore, Maryland
Keith S. Kaye
Detroit Medical Center, Wayne State University, Detroit, Michigan
Harper University Hospital, 3990 John R. Street, 5 Hudson, Detroit, MI 48201 (



To determine whether increases in contact isolation precautions are associated with decreased adherence to isolation practices among healthcare workers (HCWs).


Prospective cohort study from February 2009 to October 2009.


Eleven teaching hospitals.




One thousand thirteen observations conducted on HCWs. Additional data included the number of persons in isolation, types of HCWs, and hospital-specific contact precaution practices. Main outcome measures included compliance with individual components of contact isolation precautions (hand hygiene before and after patient encounter, donning of gown and glove upon entering a patient room, and doffing upon exiting) and overall compliance (all 5 measures together) during varying burdens of isolation.


Compliance with hand hygiene was as follows: prior to donning gowns/gloves, 37.2%; gowning, 74.3%; gloving, 80.1%; doffing of gowns/gloves, 80.1%; after gown/glove removal, 61%. Compliance with all components was 28.9%. As the burden of isolation increased (20% or less to greater than 60%), a decrease in compliance with hand hygiene (43.6%—4.9%) and with all 5 components (31.5%—6.5%) was observed. In multivariable analysis, there was an increase in noncompliance with all 5 components of the contact isolation precautions bundle (odds ratio [OR], 6.6 [95% confidence interval (CI), 1.15-37.44]; P = .03) and in noncompliance with hand hygiene prior to donning gowns and gloves (OR, 10.1 [95% CI, 1.84—55.54]; P = .008) associated with increasing burden of isolation.


As the proportion of patients in contact isolation increases, compliance with contact isolation precautions decreases. Placing 40% of patients under contact precautions represents a tipping point for noncompliance with contact isolation precautions measures.

Original Article
Copyright © The Society for Healthcare Epidemiology of America 2014

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