Assessing Isolation Care in Healthcare Workers

Background: A pilot study examined the feasibility of employing a simulated healthcare environment with video capture to assess the technique of healthcare workers (HCW) in the use of standard airborne and contact isolation precautions. The Centers for Disease Control and Prevention (CDC) have given recommendations for HCWs regarding the use of PPE in an effort to reduce the risk for transmission in novel viruses such as H1N1.  However, none of the H1N1 infected HCWs who completed a survey for the CDC responded as always using gloves, a gown, and a mask or respirator when caring for the presumed source patient.

Objective: 1) To conduct a pilot study to compare the compliance rates of HCWs with standard airborne and contact isolation precautions in a simulated patient care environment with or without access to guidelines during clinical use and 2) to evaluate video scoring as a method for identifying errors in infection control by HCWs during PPE donning, patient care, and PPE doffing procedures using a simulated environment.

Methods: The study was conducted in a simulated patient room with a study team member acting as the patient. The participants (n=10) were registered nurses, respiratory therapists, and nursing assistants assigned patient care tasks based upon their specific professional role. The participants were randomized to groups either with or without access to the CDC poster on the use of PPE in healthcare settings or to a group without access to any additional guidance. A powdered fluorescent marker was spread in common areas of the room where patient contamination may have occurred. Fluorescent marker exposure on the participant’s body was assessed after PPE removal and hand washing using a case report form and digital photography of contaminated areas. The encounters were digitally recorded during the PPE donning and doffing and during the interaction with the simulated patient. Digital video was independently reviewed by three research team members for consensus regarding compliance.

Results: This pilot study allowed for the development of an observation tool for scoring proper PPE use among HCWs. The pilot data illustrated various inconsistencies in proper PPE use among the HCWs. Some inconsistencies were noted as minor errors, while others were major safety issues.

Conclusions: This pilot study provides data on (a) HCW compliance with PPE donning and doffing, (b) the potential role of video capture in a simulated environment as an assessment tool, and (c) the benefit of a wall poster as a reminder of correct technique.  An expanded research study of these HCW behaviors will be needed to properly examine these contamination and exposure pathways and to determine the impact of the PPE guideline poster.  Ultimately, educational materials may need to be developed which specifically emphasize the common errors seen in the PPE use by HCWs.