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Published on: August 30, 2018
Contact precautions for multidrug-resistant organisms: Current recommendations and actual practice
Sarah A Clock1, Bevin Cohen, Maryam Behta
1Center for Interdisciplinary Research to Reduce Antimicrobial Resistance, Columbia University, New York, NY, USA.
Background:
Contact precautions are recommended for interactions with patients colonized/infected with multidrug-resistant organisms; however, actual rates of implementation of contact precautions are unknown.
Methods:
Observers recorded the availability of supplies and staff/visitor adherence to contact precautions at rooms of patients indicated for contact precautions. Data were collected at 3 sites in a New York City hospital network.
Results:
Contact precautions signs were present for 85.4% of indicated patients. The largest proportions were indicated for isolation for vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus cultures. Isolation carts were available outside 93.7% to 96.7% of rooms displaying signs, and personal protective equipment was available at rates of 49.4% to 72.1% for gloves (all sizes: small, medium, and large) and 91.7% to 95.2% for gowns. Overall adherence rates on room entry and exit, respectively, were 19.4% and 48.4% for hand hygiene, 67.5% and 63.5% for gloves, and 67.9% and 77.1% for gowns. Adherence was significantly better in intensive care units (P < .05) and by patient care staff (P < .05), and patient care staff compliance with one contact precautions behavior was predictive of adherence to additional behaviors (P < .001).
Conclusions:
Our findings support the recommendation that methods to monitor contact precautions and identify and correct nonadherent practices should be a standard component of infection prevention and control programs.
Insights
Contact precautions adherence is low, especially for hand hygiene, despite available supplies. Monitoring and correcting nonadherent practices are crucial for infection control in hospitals.
Area of Science:
- Infection Prevention and Control
- Hospital Epidemiology
- Patient Safety
Background:
- Contact precautions are recommended for patients with multidrug-resistant organisms.
- Actual rates of contact precaution implementation are not well-documented.
Purpose of the Study:
- To assess the availability of supplies and adherence to contact precautions.
- To identify factors influencing adherence in a hospital setting.
Main Methods:
- Direct observation of staff and visitor adherence to contact precautions.
- Data collection across 3 sites in a New York City hospital network.
- Recording availability of isolation carts and personal protective equipment.
Main Results:
- Contact precaution signs were present for 85.4% of indicated patients.
- Gown and glove availability varied (49.4%-95.2%), with lower adherence for hand hygiene (19.4%-48.4%).
- Adherence was better in ICUs and among patient care staff, with compliance predicting further adherence.
Conclusions:
- Monitoring and correcting nonadherent practices are essential components of infection control programs.
- Targeted interventions may improve contact precaution compliance.
- Standardizing monitoring methods can enhance infection prevention efforts.
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