Impact of Contact Precautions on healthcare worker behavior including frequency of visits and hand hygiene compliance

Background: Although Contact Precautions have been shown to reduce transmission of multidrug-resistant organisms, adverse effects have been reported with this intervention. Some have found that patients placed on Contact Precautions are visited less often or for a shorter duration by healthcare personnel (HCP). However, others have found that HCP who care for patients on Contact Precautions are more likely to be compliant with hand hygiene. Objective: Determine the association between Contact Precautions and HCP behavior including frequency of patient visits, time spent in the patient room and compliance with infection control precautions in a cohort of patients both on and off Contact Precautions. Methods: We completed a prospective cohort study of HCP behavior from June 2009 though November 5, 2009 in two intensive care units (Cardiac ICU and Neurocare ICU) at the University of Maryland Medical Center, Baltimore MD. A standardized data extraction sheet was used to record behavior and infection control compliance. To minimize the Hawthorne effect all observations were completed by a single observer (AY) who by design was not a member of the infection control team. Each observation period lasted one hour and every HCP visit was counted. Each observed ICU room was randomly selected each day and periods of observation occurred between 6am and 3pm. HCP were considered compliant with hand hygiene if they used alcohol hand rub or soap/water on exit. Bivariate analyses were performed using the Fisher's exact test, Student t-test or the Wilcoxon Rank Sum test using SAS v9.1. Results: 231 HCP-patient visits were observed during 107 hours of observation. 72 visits during 33 observed hours of patients on Contact Precautions and 159 visits during 74 observed hours of non-isolated patients. Overall, hand hygiene compliance was 36% on entry, 54% on exit, and 58% on either entry or exit. Compliance with Contact Precautions was 55% and time to don protective equipment in compliant individuals had a mean of 50 seconds. The number of HCP visits/hour was the same for patients on Contact Precautions vs. non-isolated patients (mean 2.18 vs. 2.19, p=0.97). The average minutes the HCP spent in the room was similar for patients on Contact Precautions vs. non-isolated patients (mean 17.1 vs 15.3 minutes, p=0.89). HCP were far more likely to be compliant with hand hygiene if caring for patients on Contact Precautions (67% vs 49%, p=0.03). Conclusions: While there has been debate concerning the benefits of Contact Precautions for reducing transmission, we found no evidence that Contact Precautions reduce the frequency of HCP visits nor does it alter the time that HCP spend in the room caring for patients. Contact Precautions was associated with improved hand hygiene compliance among HCP. Nonetheless new methods to improve compliance with both Contact Precautions and recommended hand hygiene practices are needed.