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.