Contact precautions shown to modify healthcare workers care delivery

Practice for reducing transmission of drug-resistant infections has unintended effects on care

2012-12-11

(Press-News.org) CHICAGO (December 11, 2012) – The prevention and control of healthcare-associated infections (HAIs) can help reduce patient morbidity and mortality, but a common prevention effort for patients with hard to treat infections known as contact precautions, can have positive and negative impacts on patient care. A new report published in the January issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America, found when patients with methicillin-resistant Staphylococcus aureus (MRSA) and other antibiotic-resistant bacteria are isolated in the hospital, these contact precautions reduced the number of visits by healthcare workers and outside visitors, but also increased compliance with hand hygiene upon exit of patients' rooms.

Contact precautions are infection control measures that require patients to be isolated in their own room or grouped with patients colonized or infected with the same multidrug resistant organism like Clostridium difficile or MRSA. Healthcare workers and visitors must wear gloves, gowns, and other protective equipment while with a patient on contact precautions.

Over a 19-month period, researchers conducted a prospective cohort study observing healthcare worker activity at four acute-care hospitals in the United States where trained observers performed "secret shopper" monitoring of healthcare worker activities during routine care using a standardized collection tool and fixed 1-hour observations periods.

Contact precautions were found to influence the actions of healthcare workers. Patients on contact precautions had 36.4 percent fewer visits from healthcare workers (2.78 visits/hour for patients on contact precautions and 4.37 visits/hour for those not on precautions). The difference was most evident among physicians and other providers, but less so in nurses. Importantly, healthcare workers were 15.8 percent more likely to perform hand hygiene upon exiting isolated patients' rooms.

The frequency of visitors was also impacted by contact precautions with 23 percent fewer visitors for patients on precautions.

"Our study shows that contact precautions for patients with drug resistant infections modifies the care they receive," said Daniel J. Morgan, MD, MS, a lead author of the study. "Fewer visits and increased hand hygiene are important in preventing the spread healthcare-associated infections, but clinicians and epidemiologists need to consider both the positive and negative aspects of these interventions, including the effect to patients' mental wellbeing and perception of care."

Past studies have linked contact precautions with adverse health events like patients developing delirium, increased risk of falls, or pressure ulcers.

### Daniel J. Morgan, MD, MS; Lisa Pineles, MA; Michelle Shardell, PhD; Margaret M. Graham, MPH; Shahrzad Mohammadi, BS, MPH; Graeme Forrest, MBBS; Heather S. Reisinger, PhD; Marin L. Schweizer, PhD;Eli N. Perencevich, MD, MS; "The Effect of Contact Precautions on Healthcare Worker Activity in Acute Care Hospitals." Infection Control and Hospital Epidemiology 33:1 (January 2013).

Published through a partnership between the Society for Healthcare Epidemiology of America and The University of Chicago Press, Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 15 out of 140 journals in its discipline in the latest Journal Citation Reports from Thomson Reuters.

SHEA is a professional society representing more than 2,000 physicians and other healthcare professionals around the world with expertise in healthcare epidemiology and infection prevention and control. SHEA's mission is to prevent and control healthcare-associated infections and advance the field of healthcare epidemiology. The society leads this field by promoting science and research and providing high-quality education and training in epidemiologic methods and prevention strategies. SHEA upholds the value and critical contributions of healthcare epidemiology to improving patient care and healthcare worker safety in all healthcare settings. Visit SHEA online at www.shea-online.org, www.facebook.com/SHEApreventingHAIs and @SHEA_Epi.

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