Overuse of isolation precautions and personal protective equipment

Background: Isolation precautions are important measures to prevent healthcare associated infections.  However, the use of isolation may be associated with higher rates of non-infectious adverse events such as falls and decreased patient monitoring, lower patient satisfaction, increased supply costs, and increased staff workload.  Few studies have reported the frequency of PPE and isolation over-use.

Objective: We sought to determine the frequency of unnecessary use of personal protective equipment and isolation precautions identified by a sample of practicing nurses at an academic medical center. 

Methods:   We administered a web-based survey with 10 standardized clinical scenarios.  Scenarios were developed by a panel of experts and included a brief clinical history and specific care task that was to be performed.  Participants identified the type of isolation required and selected PPE for the patient care task in the scenario. 

Results: Three hundred and seventeen nurses were asked to identify specific PPE recommended for 10 patient care scenarios.  In scenarios with no clinical indications for isolation, respondents indicated they would use gloves (42.1%), fluid shield (19.2%), N-95 respirators (13.1%), eye protection (8.3%), surgical masks (6.2%) and sterile gloves (6.2%).  In the three scenarios requiring only standard precautions, excess use of contact isolation was significantly higher in one scenario (38.7% excess use) than in two others (11.6%, and 9.3% excess use; p<.01).

Conclusions:   From this data, it appears that certain types of PPE are more likely to be over-used.  Thus, it may be appropriate to target educational interventions around indications for specific types of PPE or isolation categories.  Because unnecessary use of PPE and isolation precautions increases costs and may adversely affect patient care, future studies on methods to increase adherence should determine the frequency and implications of excess PPE use.