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

Published online by Cambridge University Press:  02 January 2015

Daniel J. Morgan ,
Lisa Pineles ,
Michelle Shardell ,
Margaret M. Graham ,
Shahrzad Mohammadi ,
Graeme N. Forrest ,
Heather S. Reisinger ,
Marin L. Schweizer  and
Eli Perencevich
Daniel J. Morgan*
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland Veterans Affairs Maryland Health Care System, Baltimore, Maryland
Lisa Pineles
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland Veterans Affairs Maryland Health Care System, Baltimore, Maryland
Michelle Shardell
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Margaret M. Graham
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa
Shahrzad Mohammadi
Affiliation:
Portland Veterans Affairs Medical Center, Portland, Oregon
Graeme N. Forrest
Affiliation:
Portland Veterans Affairs Medical Center, Portland, Oregon
Heather S. Reisinger
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Marin L. Schweizer
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa
Eli Perencevich
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
*
685 West Baltimore Street, MSTF 334D, Baltimore, MD 21201 (dmorgan@epi.umaryland.edu)
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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; 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).

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.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 1 , January 2013 , pp. 69 - 73
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013 

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