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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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2. R Jain , SM Kralovic , ME Evans , et al. Veterans affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. NEngl J Med 2011;364:14191430, doi:10.1056/NEJMoa1007474.

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16. DJ Morgan , L Pineles , M Shardell , et al. Automated hand hygiene count devices may better measure compliance than human observation. Am J Infect Control 2012,

19. A Sales , N Sharp , YF Li , 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.

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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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