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The Effect of Contact Precautions on Healthcare Worker Activity in Acute Care Hospitals

  • Daniel J. Morgan (a1) (a2), Lisa Pineles (a1) (a2), Michelle Shardell (a1), Margaret M. Graham (a3), Shahrzad Mohammadi (a4), Graeme N. Forrest (a4), Heather S. Reisinger (a3) (a5), Marin L. Schweizer (a3) and Eli Perencevich (a3) (a5)...
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.


Prospective cohort study.

Participants and Setting.

Four acute care facilities in the United States performing active surveillance for methicillin-resistant Staphylococcus aureus.


Trained observers performed “secret shopper” monitoring of HCW activities during routine care, using a standardized collection tool and fixed 1-hour observation periods.


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; P< .001 ) as well as 17.7% less direct patient contact time with HCWs (13.98 vs 16.98 minutes per hour; P = .02). Patients on contact precautions tended to have fewer visitors (23.6% fewer; P = .08). 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; P< .001).


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.

Corresponding author
685 West Baltimore Street, MSTF 334D, Baltimore, MD 21201 (
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1.Klevens RM, Edwards JR, Richards CL, et al. Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep 2007;122:160.
2.Jain R, Kralovic SM, Evans ME, et al. Veterans affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. NEngl J Med 2011;364:14191430, doi:10.1056/NEJMoa1007474.
3.Centers for Disease Control and Prevention. Vital signs: central line-associated blood stream infections-United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep 2011;60: 243248.
4.Siegel JD, Rhinehart E, Jackson M, Chiarello L; Health Care Infection Control Practices Advisory Committee. 2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35(Suppl 2):S65S164, doi:10.1016/j.ajic.2007.10.007.
5.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, doi:10.1016/j.ajic.2008.04.257.
6.Stelfox HT, Bates DW, Redelmeier DA. Safety of patients isolated for infection control. JAMA 2003;290:18991905, doi:10.1001/ jama.290.14.1899.
7.Day HR, Perencevich EN, Harris AD, et al. Association between contact precautions and delirium at a tertiary care center. Infect Control Hosp Epidemiol 2012;33:3439, doi: 10.1086/663340.
8.Gasink LB, Singer K, Fishman NO, et al. Contact isolation for infection control in hospitalized patients: is patient satisfaction affected? Infect Control Hosp Epidemiol 2008;29:275278, doi: 10.1086/527508.
9.Morgan DJ, Day HR, Harris AD, Furano JP, Perencevich EN. The impact of contact isolation on the quality of inpatient hospital care. PLoS One 2011;6:e22190, doi:10.1371/journal.pone.0022190.
10.Evans HL, Shaffer MM, Hughes MG, et al. Contact isolation in surgical patients: a barrier to care? Surgery 2003;134:180188, doi: 10.1067/msy.2003.222.
11.Kirkland KB, Weinstein JM. Adverse effects of contact isolation. Lancet 1999;354:11771178, doi:10.1016/S0140-6736(99)04196-3.
12.Trick WE, Vernon MO, Welbel SF, et al. Multicenter intervention program to increase adherence to hand hygiene recommendations and glove use and to reduce the incidence of antimicrobial resistance. Infect Control Hosp Epidemiol 2007;28:4249, doi: 10.1086/510809.
13.Fuller C, Savage J, Besser S, et al. “The dirty hand in the latex glove”: a study of hand hygiene compliance when gloves are worn. Infect Control Hosp Epidemiol 2011;32:11941199, doi: 10.1086/662619.
14.Bearman GM, Marra AR, Sessler CN, et al. A controlled trial of universal gloving versus contact precautions for preventing the transmission of multidrug-resistant organisms. Am J Infect Control 2007;35:650655, doi:10.1016/j.ajic.2007.02.011.
15.Reisinger HS, Vander Weg M, Morgan D, Forrest G, Shardell M, Perencevich E. Improving hand-hygiene compliance with point-of-use reminder signs designed using theoretical grounded messages. In: IDWeek 2012. San Diego, CA: IDWeek, October 18, 2012.
16.Morgan DJ, Pineles L, Shardell M, et al. Automated hand hygiene count devices may better measure compliance than human observation. Am J Infect Control 2012,
17.Donner A, Klar N. Design and analysis of cluster randomization trials in health research. Int J Epidemiol 2001;30:407408.
18.Saint S, Higgins LA, Nallamothu BK, Chenoweth C. Do physicians examine patients in contact isolation less frequentiy? a brief report. Am J Infect Control 2003;31:354356.
19.Sales A, Sharp N, Li YF, et al. The association between nursing factors and patient mortality in the Veterans Health Administration: the view from the nursing unit level. Med Care 2008; 46:938945, doi: 10.1097/MLR.0b013e3181791a0a.
20.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;38:515517, doi:10.1016/j.ajic.2009.11.005.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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