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“Healthcare Worker Compliance with Contact Precautions: Do as I Say, Not as I Do.”
E82
Vol. 36 No. 5
2005, 2006, and 2007. It is important to note in 2007, CHG was the primary active ingredient in the oral care regimen, leading to further VAP reduction. Conclusions: The use of an Oral Care Protocol intervention and ventilator bundle led to a 90% reduction in the rate of VAP in mechanically ventilated patients (based on the comparison of the 2007 rate with the 2004 rate). Products used in the Oral Care Protocol may have reduced the VAP rates by reducing the oral bacterial load through removal of plaque, mucous, and bacteria from the mouth and teeth and through the antibacterial activity of the antiplaque solution, hydrogen peroxide mouth wash, and subsequent addition of CHG. Routine suctioning and application of a moisturizer may also have contributed to VAP reduction.
Publication Number 8-77
‘‘Healthcare Worker Compliance with Contact Precautions: Do as I Say, Not as I Do.’’ Megan DiGiorgio, MSN, RN, Infection Control Practitioner, Daniel Cohn, Student, Science Intern, Mary Bertin, BSN, RN, CIC, Infection Control Practitioner, Jacqueline Matthews, RN, MS, Director of Quality, Steven Gordon, MD, Hospital Epidemiologist, Cleveland Clinic, Cleveland, OH. Background/Objectives: As the prevalence of multidrug-resistant organisms is increasing, so is the frequency of infection control interventions that include the use of Contact Precautions (CP). All new healthcare workers (HCW) at our institution receive education regarding hand hygiene and Contact Precautions protocols (CPP). The objective of this study was to determine HCW understanding of CPP; compliance with these protocols; and educational gaps related to CPP. Methods: The study involved directly observing the compliance to CPP among HCWs caring for patients who were appropriately identified with CP signage. A single, trained co-investigator made all of the observations between the hours of 9:00 am to 5:00 pm from June 19 to July 21, 2007. Compliance with CPP was defined as performing correct hand hygiene before and after patient contact and wearing a gown and gloves during any interaction with the patient or the patient’s immediate environment. The observer did not interact with either compliant or noncompliant HCWs. A voluntary and anonymous survey tool to assess HCW understanding of, and compliance with, CPP was also conducted during the study period. Questionnaires were placed in break rooms and nurses%92 stations in units which had patients in CP. This study was approved by the Institutional Review Board and was part of a quality improvement initiative.
June 2008
E83
Results: There were 149 observations of HCW delivering care to patients in CP during the five-week study period. Eighty-three percent of observations occurred in intensive care units. The HCWs were comprised of 60.4% [n 5 90] nurses, 15.4% [n 5 23] respiratory therapists, 9.4% [n 5 14] physicians, 11.4% [n 5 17] nursing assistants and 3.4% [n 5 5] ‘‘other’’ HCWs. Overall compliance with CPP was 25.5% [n 5 38], which did not vary significantly between job categories (p 5 0.3, chi-square analysis). Of the 74.5% [n 5 111] HCWs who were non-compliant with CPP, 52% [n 5 58] were non-compliant with gown use, 48% [n 5 53] were non-compliant with glove use and 56% [n 5 62] were non-compliant with hand hygiene. A total of 100 questionnaires were completed by 56 nurses, 16 physicians, 9 respiratory therapists, 9 nursing assistants and 10 ‘‘other’’ HCWs. Notably, 61% of HCWs who completed the questionnaire ‘‘agreed’’ or ‘‘highly agreed’’ that they are compliant with CPP. The top three selfreported barriers to compliance with CPP were ‘‘did not anticipate patient contact’’ (40%), ‘‘did not know patient was in CP’’ (32%) and ‘‘inadequate PPE supplies available’’ (32%). Conclusions: Observed compliance of HCWs with CPP was lower than self-reported compliance [25.5% vs. 61%] at our institution. Hand hygiene compliance remains the most commonly observed violation of CPP. Survey results demonstrated process issues as barriers to compliance with CPP; however, HCWs completing the survey were not necessarily those who were observed during the study period. We are focusing on interventions to improve hand hygiene as our primary platform for infection control, as well as exploring opportunity for further education, direct observation and increased Infection Control Practitioner interaction with HCWs to improve adherence to CPP.
Publication Number 8-78
Impact of Infection Control Staffing and a Hand Hygiene Program at a Community Non-Teaching Hospital Daniel Boken, M.D., Medical Director of Infection Prevention, Kaweah Delta Health Care District, Visalia, CA. Background: The relative role of infection prevention staffing, hand hygiene, and other interventions is not well described. The impact of national guidelines for these activities in the community hospital setting is also unknown. We studied the impact of improved infection prevention staffing, a hand hygiene program, and other interventions on the rate of nosocomial MRSA infections in a community, non-teaching hospital and report the relative impact of those interventions. Objective: Evaluate efficacy of improved adherence to hand hygiene guidelines and infection prevention staffing in a community non-teaching hospital on hospital acquired Methicillin Resistant Staphylococcus Aureus (MRSA) infections. Methods: Before-after interventional study. 350-bed community non-teaching acute care hospital with 98% private rooms and 22 adult critical care beds. Using standard definitions, we conducted surveillance for hospital MRSA infections beginning in 1996. In August 2003, a Hospital Epidemiologist was hired to supervise Infection Prevention activities. In 2004, a second full time ICP was hired, bringing the ratio to 0.6 per 100 occupied acute care beds. A hand hygiene program was initiated in September 2004. Alcohol based hand gel was emphasized along with direct observation of performance with immediate feedback. Secondary surveillance via discharge surveys of patients led to improved access to hand gel in 2006. Due to discharge challenges, patients were removed from contact isolation if they were at low risk of transmission (out of ICU, no open sores, able to control secretions) and standard precautions were emphasized. A central line bundle program was added in 2005. The clinical laboratory continuously monitored the percentage of isolates that were MRSA.
Vol. 36 No. 5
2005, 2006, and 2007. It is important to note in 2007, CHG was the primary active ingredient in the oral care regimen, leading to further VAP reduction. Conclusions: The use of an Oral Care Protocol intervention and ventilator bundle led to a 90% reduction in the rate of VAP in mechanically ventilated patients (based on the comparison of the 2007 rate with the 2004 rate). Products used in the Oral Care Protocol may have reduced the VAP rates by reducing the oral bacterial load through removal of plaque, mucous, and bacteria from the mouth and teeth and through the antibacterial activity of the antiplaque solution, hydrogen peroxide mouth wash, and subsequent addition of CHG. Routine suctioning and application of a moisturizer may also have contributed to VAP reduction.
Publication Number 8-77
‘‘Healthcare Worker Compliance with Contact Precautions: Do as I Say, Not as I Do.’’ Megan DiGiorgio, MSN, RN, Infection Control Practitioner, Daniel Cohn, Student, Science Intern, Mary Bertin, BSN, RN, CIC, Infection Control Practitioner, Jacqueline Matthews, RN, MS, Director of Quality, Steven Gordon, MD, Hospital Epidemiologist, Cleveland Clinic, Cleveland, OH. Background/Objectives: As the prevalence of multidrug-resistant organisms is increasing, so is the frequency of infection control interventions that include the use of Contact Precautions (CP). All new healthcare workers (HCW) at our institution receive education regarding hand hygiene and Contact Precautions protocols (CPP). The objective of this study was to determine HCW understanding of CPP; compliance with these protocols; and educational gaps related to CPP. Methods: The study involved directly observing the compliance to CPP among HCWs caring for patients who were appropriately identified with CP signage. A single, trained co-investigator made all of the observations between the hours of 9:00 am to 5:00 pm from June 19 to July 21, 2007. Compliance with CPP was defined as performing correct hand hygiene before and after patient contact and wearing a gown and gloves during any interaction with the patient or the patient’s immediate environment. The observer did not interact with either compliant or noncompliant HCWs. A voluntary and anonymous survey tool to assess HCW understanding of, and compliance with, CPP was also conducted during the study period. Questionnaires were placed in break rooms and nurses%92 stations in units which had patients in CP. This study was approved by the Institutional Review Board and was part of a quality improvement initiative.
June 2008
E83
Results: There were 149 observations of HCW delivering care to patients in CP during the five-week study period. Eighty-three percent of observations occurred in intensive care units. The HCWs were comprised of 60.4% [n 5 90] nurses, 15.4% [n 5 23] respiratory therapists, 9.4% [n 5 14] physicians, 11.4% [n 5 17] nursing assistants and 3.4% [n 5 5] ‘‘other’’ HCWs. Overall compliance with CPP was 25.5% [n 5 38], which did not vary significantly between job categories (p 5 0.3, chi-square analysis). Of the 74.5% [n 5 111] HCWs who were non-compliant with CPP, 52% [n 5 58] were non-compliant with gown use, 48% [n 5 53] were non-compliant with glove use and 56% [n 5 62] were non-compliant with hand hygiene. A total of 100 questionnaires were completed by 56 nurses, 16 physicians, 9 respiratory therapists, 9 nursing assistants and 10 ‘‘other’’ HCWs. Notably, 61% of HCWs who completed the questionnaire ‘‘agreed’’ or ‘‘highly agreed’’ that they are compliant with CPP. The top three selfreported barriers to compliance with CPP were ‘‘did not anticipate patient contact’’ (40%), ‘‘did not know patient was in CP’’ (32%) and ‘‘inadequate PPE supplies available’’ (32%). Conclusions: Observed compliance of HCWs with CPP was lower than self-reported compliance [25.5% vs. 61%] at our institution. Hand hygiene compliance remains the most commonly observed violation of CPP. Survey results demonstrated process issues as barriers to compliance with CPP; however, HCWs completing the survey were not necessarily those who were observed during the study period. We are focusing on interventions to improve hand hygiene as our primary platform for infection control, as well as exploring opportunity for further education, direct observation and increased Infection Control Practitioner interaction with HCWs to improve adherence to CPP.
Publication Number 8-78
Impact of Infection Control Staffing and a Hand Hygiene Program at a Community Non-Teaching Hospital Daniel Boken, M.D., Medical Director of Infection Prevention, Kaweah Delta Health Care District, Visalia, CA. Background: The relative role of infection prevention staffing, hand hygiene, and other interventions is not well described. The impact of national guidelines for these activities in the community hospital setting is also unknown. We studied the impact of improved infection prevention staffing, a hand hygiene program, and other interventions on the rate of nosocomial MRSA infections in a community, non-teaching hospital and report the relative impact of those interventions. Objective: Evaluate efficacy of improved adherence to hand hygiene guidelines and infection prevention staffing in a community non-teaching hospital on hospital acquired Methicillin Resistant Staphylococcus Aureus (MRSA) infections. Methods: Before-after interventional study. 350-bed community non-teaching acute care hospital with 98% private rooms and 22 adult critical care beds. Using standard definitions, we conducted surveillance for hospital MRSA infections beginning in 1996. In August 2003, a Hospital Epidemiologist was hired to supervise Infection Prevention activities. In 2004, a second full time ICP was hired, bringing the ratio to 0.6 per 100 occupied acute care beds. A hand hygiene program was initiated in September 2004. Alcohol based hand gel was emphasized along with direct observation of performance with immediate feedback. Secondary surveillance via discharge surveys of patients led to improved access to hand gel in 2006. Due to discharge challenges, patients were removed from contact isolation if they were at low risk of transmission (out of ICU, no open sores, able to control secretions) and standard precautions were emphasized. A central line bundle program was added in 2005. The clinical laboratory continuously monitored the percentage of isolates that were MRSA.