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Contact Precautions More Is Not Necessarily Better

Published online by Cambridge University Press:  10 May 2016

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

Abstract

Objective.

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

Design.

Prospective cohort study from February 2009 to October 2009.

Setting.

Eleven teaching hospitals.

Participants.

HCWs.

Methods.

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.

Results.

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.

Conclusions.

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.

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

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References

1. Klevens, RM, Edwards, JR, Cardo, DM. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007;122(2):160166.Google Scholar
2. Hidron, AI, Edwards, JR, Patel, J, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol 2008;29(11):9961011.Google Scholar
3. Lujan, M, Gallego, M, Relio, J. Healthcare-associated infections: a useful concept? Curr Opin Crit Care 2009;15(5):419424.Google Scholar
4. Malacarne, P, Boccalatte, D, Acquarolo, A, et al. Epidemiology of nosocomial infection in 125 Italian intensive care units. Minerva Anestesiol 2010;76(1):1323.Google ScholarPubMed
5. Foglia, EE, Fraser, VJ, Elward, AM. Effect of nosocomial infections due to antibiotic-resistant organisms on length of stay and mortality in the pediatric intensive care unit. Infect Control Hosp Epidemiol 2007;28(3):299306.Google Scholar
6. Muto, CA, Jernigan, JA, Ostrowsky, BE, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24(5):362386.Google Scholar
7. Strausbaugh, LJ, Siegel, JD, Weinstein, RA. Preventing transmission of multidrug-resistant bacteria in health care settings: a tale of 2 guidelines. Clin Infect Dis 2006;42(6):828835.Google Scholar
8. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Healthcare Infection Control Practices Advisory Committee. 2007 guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. Am J Infect Control 2007;35(10 suppl 2):S65S164.Google Scholar
9. Jain, R, Kralovic, SM, Evans, ME, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011;364(15):14191430.Google Scholar
10. Huskins, WC, Huckabee, CM, O'Grady, NP, et al. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 2011;364(15):14071418.Google Scholar
11. Müder, RR, Cunningham, C, McCray, E, et al. Implementation of an industrial systems-engineering approach to reduce the incidence of methicillin-resistant Staphylococcus aureus infection. Infect Control Hosp Epidemiol 2008;29(8):702708.Google Scholar
12. Jernigan, JA, Titus, MG, Groschel, DH, Getchell-White, S, Farr, BM. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus . Am J Epidemiol 1996;143(5):496504.Google Scholar
13. Slaughter, S, Hayden, MK, Nathan, C, et al. A comparison of the effect of universal use of gloves and gowns with that of glove use alone on acquisition of vancomycin-resistant enterococci in a medical intensive care unit. Ann Intern Med 1996;125(6):448456.Google Scholar
14. Leclair, JM, Freeman, J, Sullivan, BF, Crowley, CM, Goldmann, DA. Prevention of nosocomial respiratory syncytial virus infections through compliance with glove and gown isolation precautions. N Engl J Med 1987;317(6):329334.CrossRefGoogle ScholarPubMed
15. Safdar, N, Marx, J, Meyer, NA, Maki, DG. Effectiveness of preemptive barrier precautions in controlling nosocomial colonization and infection by methicillin-resistant Staphylococcus aureus in a burn unit. Am J Infect Control 2006;34(8):476483.Google Scholar
16. Gasink, LB, Brennan, PJ. Isolation precautions for antibiotic-resistant bacteria in healthcare settings. Curr Opin Infect Dis 2009;22(4):339344.Google Scholar
17. Klein, BS, Perloff, WH, Maki, DG. Reduction of nosocomial infection during pediatric intensive care by protective isolation. N Engl J Med 1989;320(26):17141721.Google Scholar
18. Slota, M, Green, M, Farley, A, Janosky, J, Carrillo, J. The role of gown and glove isolation and strict handwashing in the reduction of nosocomial infection in children with solid organ transplantation. Crit Care Med 2001;29(2):405412.Google Scholar
19. 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(15):15711580.Google Scholar
20. Clock, SA, Cohen, B, Behta, M, Ross, B, Larson, EL. Contact precautions for multidrug-resistant organisms: current recommendations and actual practice. Am J Infect Control 2010;38(2):105111.Google Scholar
21. Manían, FA, Ponzillo, JJ. Compliance with routine use of gowns by healthcare workers (HCWs) and non-HCW visitors on entry into the rooms of patients under contact precautions. Infect Control Hosp Epidemiol 2007;28(3):337340.Google Scholar
22. Weber, DJ, Sickbert-Bennett, EE, Brown, VM, et al. Compliance with isolation precautions at a university hospital. Infect Control Hosp Epidemiol 2007;28(3):358361.CrossRefGoogle ScholarPubMed
23. 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(7):515517.Google Scholar
24. Pittet, D, Hugonnet, S, Harbarth, S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356(9238):13071312.Google Scholar
25. 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(2)8593.Google Scholar
26. Zastrow, RL. Emerging infections: the contact precautions controversy. Am J Nurs 2011;111(3):4753.Google Scholar
27. Kirkland, KB, Weinstein, JM. Adverse effects of contact isolation. Lancet 1999;354(9185):11771178.Google Scholar
28. Morgan, DJ, Day, HR, Harris, AD, Furuno, JP, Perencevich, EN. The impact of contact isolation on the quality of inpatient hospital care. PLoS One 2011;6(7):e22190.Google Scholar
29. Stelfox, HT, Bates, DW, Redelmeier, DA. Safety of patients isolated for infection control. JAMA 2003;290(14):18991905.Google Scholar
30. Hannigan, P, Shields, JW, Handwashing and use of examination gloves. Lancet 1998;351(9102):571.Google Scholar
31. Doebbeling, BN, Pfaller, MA, Houston, AK, Wenzel, RP. Removal of nosocomial pathogens from the contaminated glove: implications for glove reuse and handwashing. Ann Intern Med 1988; 109(5):394398.Google Scholar
32. Morgan, DJ, Liang, SY, Smith, CL, et al. Frequent multidrug-resistant Acinetobacter baumannii contamination of gloves, gowns, and hands of healthcare workers. Infect Control Hosp Epidemiol 2010;31(7):716721.Google Scholar
33. Pittet, D. The Lowbury lecture: behaviour in infection control. J Hosp Infect 2004;58(1):113.Google Scholar
34. Whitby, M, Pessoa-Silva, CL, McLaws, ML, et al. Behavioural considerations for hand hygiene practices: the basic building blocks. J Hosp Infect 2007;65(1):l8.Google Scholar
35. Dhar, S, Tansek, R, Toftey, EA, et al., Observer bias in hand hygiene compliance reporting. Infect Control Hosp Epidemiol 2010;31(8):869970.Google Scholar
36. Saint, S, Higgins, LA, Nallamothu, BK, Chenoweth, C. Do physicians examine patients in contact isolation less frequently? a brief report. Am J Infect Control 2003;31(6):354356.Google Scholar