Healthcare worker (HCW) Opinions of Contact Isolation Precautions in Long-term Care Facilities (LTCFs)

Background: The use of contact isolation precautions in LTCFs remains a controversial issue. HCWs providing direct care to older adults in LTCFs may be best suited to provide insight into the benefits and hazards of isolating older adults.  

Objective: To assess HCW opinions regarding contact isolation precautions to reduce transmission of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE).

Methods: We surveyed all nurses and nurses’ aides in 7 community LTCFs in SE Michigan between Aug -Dec 2006. This anonymous, self-administered survey was pilot tested and included open-ended questions about respondent characteristics and knowledge and opinions regarding contact precautions for MRSA and VRE. Open-ended questions were used to explore a full range of possible themes. Respondents could provide up to 5 self-worded responses regarding the benefits and harmful effects of contact isolation. These were then grouped into specific themes by the study team. HCWs were also asked if they would change their infection control practices based on the residents’ MRSA or VRE status. Chi-square tests were used to compare differences between groups.

Results: A total of 355 of 440 employees (81%) responded. Respondents were significantly more likely to answer that residents with MRSA should be isolated compared to VRE (61% vs. 41%, p<0.01). However, only 36% would change their infection control practices if they knew that a resident was MRSA or VRE positive. Interestingly, nurses aides were significantly more likely than nurses to respond that MRSA and VRE patients should be isolated (MRSA: 46% vs. 27%, VRE: 42% vs. 27%, p<0.01 for both). Seventy-six percent (271/355) of HCWs provided 378 unique answers regarding the potential benefits of isolation for MRSA and 54% (190/355) of HCWs provided 190 responses on the potential benefits of isolation for VRE.  However, in total only 67% (236/355) and 40% (143/355) responded that isolation prevents MRSA and VRE transmission, respectively. Seventy-three percent (259/355) of HCWs provided 487 unique answers and 52% (183/355) of HCWs provided 332 unique responses on the potential harmful effects of isolation for MRSA and VRE, respectively. In total, for MRSA 86% responded that isolation had significant psycho-social harms including depression (76%), confusion (19%), and lowering dignity or self esteem (18%). Responses were similar for VRE.

Conclusions: Compared with the nurses, nurses’ aides were more likely to advocate for isolation for MRSA and VRE in LTCFs perhaps due to the increased amount of time they spent with the LTCF residents.  Nurses and nurses’ aides provided useful insights into the benefits and harms of isolation practices in LTCFs which can influence policy as well as their compliance with these measures.