The Effect of Contact Precautions on Healthcare Worker Activity in Acute Care Hospitals
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; [Formula: see text]) as well as 17.7% less direct patient contact time with HCWs (13.98 vs 16.98 minutes per hour; [Formula: see text]). Patients on contact precautions tended to have fewer visitors (23.6% fewer; [Formula: see text]). 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; [Formula: see text]). 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.
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ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of morbidity and mortality in healthcare facilities. Residents of nursing homes are commonly colonized with MRSA and acquisition within these facilities is common. While treatment of MRSA infection in the NH is more costly than treatment of infections caused by methicillin-susceptible strains, the frequency of serious infections and attributable mortality remains uncommon. Consequently, controlling the spread of MRSA in NHs is primarily a population health concern and interventions to control intrafacility transmissions should be balanced with a concern for resident quality-of-life.09/2013; 2(3). DOI:10.1007/s13670-013-0047-4
- Clinical Infectious Diseases 04/2013; 57(2). DOI:10.1093/cid/cit214
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ABSTRACT: BACKGROUND:To prevent transmission, some pediatric units require clinicians to wear gloves for all patient contacts during RSV season. We sought to assess whether a mandatory gloving policy reduced the risk of other health care-acquired infections (HAIs).METHODS:This retrospective cohort study included all patients admitted to pediatric units of a tertiary care center between 2002 and 2010. Poisson regression models were used to measure the association between mandatory gloving and HAI incidence. Autoregressive models were used to adjust for time correlation.RESULTS:During the study period, 686 HAIs occurred during 363 782 patient-days. The risk of any HAI was 25% lower during mandatory gloving periods compared with during nongloving periods (relative risk [RR]: 0.75; 95% confidence interval [CI]: 0.69-0.93; P = .01), after adjusting for long-term trends and seasonal effect. Mandatory gloving was associated with lower risks of bloodstream infections (RR: 0.63; 95% CI: 0.49-0.81; P < .001), central line-associated bloodstream infections (RR: 0.61; 95% CI: 0.44-0.84; P = 0.003), and hospital-acquired pneumonia (RR: 0.20; 95% CI: 0.03-1.25; P= 0.09). The reduction was significant in the PICU (RR: 0.63; 95% CI: 0.42-0.93; P = .02), the NICU (RR: 0.62; 95% CI: 0.39-0.98; P = .04), and the Pediatric Bone Marrow Transplant Unit (RR: 0.52; 95% CI: 0.29-0.91, P = .02).CONCLUSIONS:Universal gloving during RSV season was associated with significantly lower rates of bacteremia and central line-associated bloodstream infections, particularly in the ICUs and the Pediatric Bone Marrow Transplant Unit.PEDIATRICS 04/2013; 131(5). DOI:10.1542/peds.2012-3389