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679 Contact Isolation Precautions: More is not Necessarily Better

Saturday, March 20, 2010: 3:15 PM
Centennial III-IV (Hyatt Regency Atlanta)
Dror Marchaim, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Keith S. Kaye, MD, MPH , Detroit Medical Center, Wayne State University, Detroit, MI
Teena Chopra, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Ryan Tansek, BS , Detroit Medical Center, Wayne State University, Detroit, MI
Khawar Chaudry, BS , Detroit Medical Center, Wayne State University, Detroit, MI
Adnan Yousuf, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Ashish Bhargava, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Ting-yi Chen, MD, MPH , Detroit Medical Center, Wayne State University, Detroit, MI
Al Dababneh, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Thientu Trong, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Hesham Fakhry, MD , Detroit Medical Center, Wayne State University, Detroit, MI
George Alangaden, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Elaine Flanagan, MSA, CIC , Detroit Medical Center, Wayne State University, Detroit, MI
Thomas R. Talbot, MD, MPH , Vanderbilt University, Nashville, TN
Laura Johnson, MD , Henry Ford Health System, Detroit, MI
Ameet Hingwe, MD , Henry Ford Health System, Detroit, MI
Jerry Zuckerman, MD , Albert Einstein Med Ctr, Philadelphia, PA
Bartholomew R. Bono, MD , Albert Einstein Med Ctr, Philadelphia, PA
Emily Shuman, MD , University of Michigan, Ann Arbor, MI
Virginia Abell, RN, CIC , Summa Health System, Akron, OH
Jose Poblete, MD , Summa Health System, Akron, OH
MaryAnn Tran, MD , Sparrow Hospital, Michigan State University, Lansing, MI
Grace Kim, MD , Sparrow Hospital, Michigan State University, Lansing, MI
Won Chung, MD , Sparrow Hospital, Michigan State University, Lansing, MI
Rama Thyagarajan, MD , Oakwood Health Care System, Dearborn, MI
Vijayalakshmi Nagappan, MD , Oakwood Health Care System, Dearborn, MI
Carrie A. Herzke, MD , Johns Hopkins Medical Institute, Baltimore, MD
Trish Perl, MD, MSc , The Johns Hopkins Hospital, Baltimore, MD
Sorabh Dhar, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Background: Contact isolation precautions (CIP) are widely employed to decrease hospital transmission of multi-drug resistant organisms (MDROs). Despite the proven efficacy of this method, compliance among healthcare workers (HCWs) varies considerably. Factors contributing to this include the lack of routine compliance monitoring, variations in definitions, and an increasing organism burden for which CIP are utilized. Guidelines for CIP are available, however are non-specific and may be interpreted or implemented differently based on local experiences (i.e. outbreaks) and overall MDRO burden.

Objective: To analyze compliance with CIP by HCWs as a function of: 1) the proportion of patients in CIP on a given unit; and 2) the number of MDROs for which a hospital requires CIP.  We hypothesized that hospitals with focused MDRO isolation parameters and relatively few patients on CIP would achieve higher HCW compliance rates.

Methods: A nationwide, multi-center, prospective observational study was conducted in 11 hospitals in 5 different states from 03-01 to 11-12, 2009.  Anonymous observers recorded: a) type of unit; b) the number of patients on CIP; c) type of HCW being observed; and d) 5 CIP parameters. The CIP parameters included: 1) Hand hygiene (HH) before placing gown/glove; 2) Gowning before entering patient room; 3) Gloving before entering patient room; 4) Gown/Glove removal after encounter; and 5) HH after removal of Gown/Glove. Other data obtained included the number and types of MDROs for which CIP are used, as well as the location (i.e. units/floors) for which CIP are routinely applied. The data was analyzed using SPSS statistical software.

Results: A total of 983 observations from 11 hospitals were collected. 524 were from general floors and 457 from ICUs.  229 (23%) observations were of doctors and 584 (59%) were of nurses. Two-hundred and forty-five (25%) of observations were of HCW’s who were compliant with all 5 parameters of CIP (including HH).  The overall mean number of CIP parameters adhered to was 3.3±0.05. The compliance rate with CIP was inversely related to the proportion of patients on precautions on a given unit: for compliant HCWs (n=245), a mean of 18% of patients were on CIP compared to non-compliant HCWs (n=693) where 23% of patients were on CIP (p<0.001).   The rate of CIP compliance was also lower in units that isolate for 4 or more MDROs compared to those units requiring CIP for < 4 (21% vs. 29%, p=0.23).

Conclusions: Compliance with CIP was low across multiple hospitals.  Increased indications for CIP and burden of MDROs were associated with decreased HCW compliance.  Hospitals should weigh the implications of decreased HCW compliance when implementing widespread CIP, and consider targeting CIP practices towards MDROs that pose particular threats to their patient populations.