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

Published online by Cambridge University Press:  02 April 2018

Lisa Pineles ,
Chris Petruccelli ,
Eli N. Perencevich ,
Mary-Claire Roghmann ,
Kalpana Gupta ,
Jose Cadena ,
Gio Baracco ,
Christopher D. Pfeiffer ,
Graeme Forrest  and
Suzanne F. Bradley
...Show all authors
Lisa Pineles*
Affiliation:
VA Maryland Health Care System, Baltimore, Maryland
Chris Petruccelli
Affiliation:
VA Maryland Health Care System, Baltimore, Maryland
Eli N. Perencevich
Affiliation:
Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Mary-Claire Roghmann
Affiliation:
VA Maryland Health Care System, Baltimore, Maryland
Kalpana Gupta
Affiliation:
VA Boston Health Care System, Boston, Massachusetts
Jose Cadena
Affiliation:
South Texas Veterans Health Care System, San Antonio, Texas
Gio Baracco
Affiliation:
Miami Veterans Affairs Healthcare System, Miami, Florida
Christopher D. Pfeiffer
Affiliation:
Veterans Affairs Portland Healthcare System, Portland, Oregon Oregon Health & Science University, Portland, Oregon
Graeme Forrest
Affiliation:
Veterans Affairs Portland Healthcare System, Portland, Oregon Oregon Health & Science University, Portland, Oregon
Suzanne F. Bradley
Affiliation:
Infectious Diseases Section, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
Chris Crnich
Affiliation:
Infectious Diseases Section, William S. Middleton VA, Madison, Wisconsin
Heather Reisinger
Affiliation:
Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Daniel J. Morgan
Affiliation:
VA Maryland Health Care System, Baltimore, Maryland
*
Address correspondence to Lisa Pineles, MA, 10 S Pine St, MSTF 360B, Baltimore, MD 21201 (lpineles@som.umaryland.edu).
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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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 6 , June 2018 , pp. 683 - 687
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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