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129 Healthcare workers' adherence with contact precautions in rooms of patients with Clostridium difficile infection or methicillin-resistant Staphylococcus aureus carriage

Saturday, April 2, 2011
Trinity Ballroom (Hilton Anatole)
Trina F. Zabarsky, MSN , Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH
Rose Pettiti , Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH
Elizabeth R. Flannery , Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH
Curtis J. Donskey , Louis Stokes Cleveland Veterans Affairs Medical Center, Clevland, OH

Background: Contact precautions are commonly used to reduce the risk for transmission of healthcare-associated pathogens such as Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA). However, the frequency of routine monitoring of adherence with contact precautions by healthcare facilities is not known and there are few reports of rates of adherence to these measures by healthcare workers.

Objective: To survey VA and non-VA hospitals to assess practices for monitoring contact precautions, and to determine rates of compliance with contact precautions in a VA hospital.

Methods: We surveyed VA hospitals nationwide and non-VA hospitals in Northeast Ohio to determine practices for monitoring of adherence with contact precautions. In a VA hospital, observers recorded adherence to contact precautions measures for patients with C. difficile infection (CDI) or MRSA carriage. Adherence was compared for physicians, nurses, and other providers, for CDI versus MRSA rooms, and for healthcare workers entering individually versus with a group.

Results: Of the hospitals that responded to the survey, 37 of 58 (64%) VA hospitals and 5 of 12 (42%) non-VA hospitals routinely monitored compliance with contact precautions through direct observation. In the VA hospital, overall adherence with gown use, glove use, and hand hygiene on room exit in CDI and MRSA isolation rooms are shown in the figure.  Healthcare workers were significantly more adherent with glove and gown use when interacting with CDI patients versus MRSA patients (P =0.028). When interacting with CDI patients, adherence with gown and glove use were significantly more common if healthcare workers entered with a group versus alone (P ≤0.033). There were no significant differences in rates of adherence for physicians, nurses, or other personnel.

Conclusions: Our findings suggest that there is a need for routine monitoring of adherence to contact precautions in healthcare facilities with feedback to healthcare workers.