Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-24T06:20:36.177Z Has data issue: false hasContentIssue false
  • English
  • Français

Effectiveness of a multisite personal protective equipment (PPE)–free zone intervention in acute care

Published online by Cambridge University Press:  07 June 2019

Lindsay D. Visnovsky Open the ORCID record for Lindsay D. Visnovsky [Opens in a new window] ,
Yue Zhang ,
Molly K. Leecaster ,
Nasia Safdar ,
Lauren Barko ,
Candace Haroldsen ,
Diane L. Mulvey ,
McKenna Nevers ,
Catherine Shaughnessy  and
Kristina M. Stratford
...Show all authors
Lindsay D. Visnovsky*
Affiliation:
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, Utah
Yue Zhang
Affiliation:
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, Utah
Molly K. Leecaster
Affiliation:
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, Utah
Nasia Safdar
Affiliation:
William S. Middleton VA Hospital, Madison, Wisconsin Division of Infectious Diseases, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
Lauren Barko
Affiliation:
Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
Candace Haroldsen
Affiliation:
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, Utah
Diane L. Mulvey
Affiliation:
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, Utah
McKenna Nevers
Affiliation:
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, Utah
Catherine Shaughnessy
Affiliation:
Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
Kristina M. Stratford
Affiliation:
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, Utah
Frank A. Drews
Affiliation:
Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, Utah Department of Psychology, University of Utah, Salt Lake City, Utah
Matthew H. Samore
Affiliation:
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, Utah
Jeanmarie Mayer
Affiliation:
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, Utah
*
Author for correspondence: Lindsay D. Visnovsky, Email: lindsay.visnovsky@hsc.utah.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Determine the effectiveness of a personal protective equipment (PPE)-free zone intervention on healthcare personnel (HCP) entry hand hygiene (HH) and PPE donning compliance in rooms of patients in contact precautions.

Design:

Quasi-experimental, multicenter intervention, before-and-after study with concurrent controls.

Setting:

All patient rooms on contact precautions on 16 units (5 medical-surgical, 6 intensive care, 5 specialty care units) at 3 acute-care facilities (2 academic medical centers, 1 Veterans Affairs hospital). Observations of PPE donning and entry HH compliance by HCP were conducted during both study phases. Surveys of HCP perceptions of the PPE-free zone were distributed in both study phases.

Intervention:

A PPE-free zone, where a low-risk area inside door thresholds of contact precautions rooms was demarcated by red tape on the floor. Inside this area, HCP were not required to wear PPE.

Results:

We observed 3,970 room entries. HH compliance did not change between study phases among intervention units (relative risk [RR], 0.92; P = .29) and declined in control units (RR, 0.70; P = .005); however, the PPE-free zone did not significantly affect compliance (P = .07). The PPE-free zone effect on HH was significant only for rooms on enteric precautions (P = .008). PPE use was not significantly different before versus after the intervention (P = .15). HCP perceived the zone positively; 65% agreed that it facilitated communication and 66.8% agreed that it permitted checking on patients more frequently.

Conclusions:

HCP viewed the PPE-free zone favorably and it did not adversely affect PPE or HH compliance. Future infection prevention interventions should consider the complex sociotechnical system factors influencing behavior change.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 7 , July 2019 , pp. 761 - 766
Creative Commons
This work is classified, for copyright purposes, as a work of the U.S. Government and is not subject to copyright protection within the United States.
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION: Some of the data reported in this article were presented at IDWeek 2018, on October 3-7, 2018, in San Francisco, California.

References

Siegel, JD, Rhinehart, E, Jackson, M, et al. Healthcare Infection Control Practices Advisory Committee. 2007 guideline for isolation precautions: prevention transmission of infectious agents in health care settings. Am J Infect Control 2007;35:S65–S164.CrossRefGoogle Scholar
Yanke, E, Moriarty, H, Carayon, P, Safdar, N. A qualitative, interprofessional analysis of barriers to and facilitators of implementation of the Department of Veterans Affairs’ Clostridium difficile prevention bundle using a human factors engineering approach. Am J Infect Control 2018;46:276–284.CrossRefGoogle ScholarPubMed
Siebert, DJ, Speroni, KG, Oh, KM, Devoe, MC, Jacobsen, KH. Preventing transmission of MRSA: a qualitative study of healthcare workers’ attitudes and suggestions. Am J Infect Control 2014;42:405–411.CrossRefGoogle Scholar
Guillemin, I, Marrel, A, Beriot-Mathiot, A, et al. How do Clostridium difficile infections affect nurses’ everyday hospital work: a qualitative study. In J Nurs Pract 2015;21:38–45.CrossRefGoogle ScholarPubMed
Yanke, E, Zellmer, C, Van Hoof, S, Moriarty, H, Carayon, P, Safdar, N. Understanding the current state of infection prevention to prevent Clostridium difficile infection: a human factors and systems engineering approach. Am J Infect Control 2015;43:241–247.CrossRefGoogle ScholarPubMed
Dashiell-Earp, CN, Bell, DS, Ang, AO, Uslan, DZ. Do physicians spend less time with patients in contact isolation? A time-motion study of internal medicine interns. JAMA Intern Med 2014;174:814–815.CrossRefGoogle ScholarPubMed
Evans, HL, Shaffer, MM, Hughes, MG, et al. Contact isolation in surgical patients: a barrier to care? Surgery 2003;134:180–188.CrossRefGoogle ScholarPubMed
Morgan, DJ, Pineles, L, Shardell, M, et al. The effect of contact precautions on healthcare worker activity in acute care hospitals. Infect Control Hosp Epidemiol 2013;34:69–73.CrossRefGoogle ScholarPubMed
Bardossy, AC, Alsafadi, MY, Starr, P, et al. Evaluation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus. Am J Infect Control 2017;45:1369–1371.CrossRefGoogle ScholarPubMed
Renaudin, L, Llorens, M, Goetz, C, et al. Impact of discontinuing contact precautions for MRSA and ESBLE in an intensive care unit: a prospective noninferiority before and after study. Infect Control Hosp Epidemiol 2017;38:1342–1350.CrossRefGoogle Scholar
Edmond, M, Masroor, N, Stevens, MP, Ober, J, Bearman, G. The impact of discontinuing contact precautions for VRE and MRSA on device-associated infections. Infect Control Hosp Epidemiol 2015;36:978–980.CrossRefGoogle ScholarPubMed
Rubin, MA, Samore, MH, Harris, AD. The importance of contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci. JAMA 2018;319:863–4.CrossRefGoogle ScholarPubMed
Salim, T. Red box: creating a safe zone to improve communication with isolated patients. In: Program and abstracts of IDWeek 2017; October 4–8, 2017; San Diego, CA. Abstract 422.Google Scholar
Franck, JN, Behan, AZ, Herath, PS, Mueller, AC, Marhoefer, KA. The red box strategy: an innovative method to improve isolation precaution compliance and reduce costs. In: Program and abstracts of the Association for Professionals in Infection Prevention 38th Annual Conference; 2011; Baltimore, MD. Abstract 123.CrossRefGoogle Scholar
Pollard, MA, Wickens, K. The red box strategy for contact precautions. In: Program and abstracts of the 25th International Nursing Research Congress; July 24–28, 2014; Hong Kong. Abstract session M12.Google Scholar
Snell, D. Improving isolation practice and compliance with a little red box. In: Program and abstracts of the Association for Professionals in Infection Prevention 40th Annual Conference; June 8–10, 2013; Fort Lauderdale, FL. Abstract 5-307.Google Scholar
Blomberg, D. Safe zone: taking the red box to the next step. In: Program and abstracts of the Association for Professionals in Infection Prevention 41st Annual Conference; June 7–9, 2014; Anaheim, CA. Abstract 6-200.Google Scholar
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;38:105–111.CrossRefGoogle ScholarPubMed
Katanami, Y, Hayakawa, K, Shimazaki, T, et al. Adherence to contact precautions by differing types of healthcare workers through video monitoring in a tertiary hospital. J Hosp Infect 2018;100:70–75.CrossRefGoogle Scholar
Morgan, DJ, Wenzel, RP, Bearman, G. Contact precautions for endemic MRSA and VRE: time to retire legal mandates. JAMA 2017;318:329–330.CrossRefGoogle ScholarPubMed
Krein, SL, Mayer, J, Harrod, M, et al. Identification and characterization of failures in infectious agent transmission precaution practices in hospitals: A qualitative study. JAMA Intern Med 2018;178:1051–1057.CrossRefGoogle ScholarPubMed
Supplementary material: File

Visnovsky et al. supplementary material

Visnovsky et al. supplementary material 1

Download Visnovsky et al. supplementary material(File)
File 280.2 KB