Studies Shed Light on Isolation Precaution Practices -- by Robin Walters, R.N., B.S.N.

Robin Walters, R.N., B.S.N., has been privileged to provide care in hospitals, clinics, schools and physician offices, at sites ranging from large urban to remote rural. Be sure to also read Robin's other contributions on bloodstream infections, hand washing compliance, and culture of safety.

Timely and consistent use of isolation measures can prevent untold thousands of hospital-acquired infections each year.  Depending on the infectious agent, required precautions may include:  a private room, dedicated patient-care equipment, room air pressure and ventilation measures, and/or the appropriate use of personal protective equipment such as masks, gowns and gloves.  The following studies highlight strengths and weaknesses in compliance at three major medical centers and may assist other facilities in focusing their improvement efforts.

At the University of North Carolina Hospitals in Chapel Hill, infection control personnel observed staff and visitors in 2004 and 2005, finding the overall rate of compliance by type of isolation ranged from 60-75%.  For contact isolation, which is designed to prevent infections transmitted by direct or indirect contact with a patient or a patient's environment, researchers assessed gown and glove use.  In the ICUs, compliance ranged from 92-100% for both staff and visitors.  But on the adult floors, perhaps as expected, visitor gown (50%) and glove (33%) use was much lower than staff gown (81%) and glove (81%) use.  On the pediatric floors, rates of gown and glove use varied even more between visitors (23% and 5%) and staff (87% and 93%).

Over the same time period, observers at St. John's Mercy Medical Center Hospital in St. Louis, MO documented adherence by health care workers (HCWs) and non-HCW visitors to the facility's modified contact precautions, which include donning gown and gloves before entering a patient's room regardless of whether direct contact is anticipated.  Among HCWs, females and those working in the ICUs complied best.  Visitors in the ICUs complied better than those on the general floors (91% vs. 51%).

HCWs at the eight Shiraz Univerisity of Medical Sciences hospitals in Iran were surveyed in 2002 to assess beliefs and behaviors related to CDC standards for isolation precautions.  The results revealed a wide gap in prior infection control training between physicians (11%) and nurses (66%) and showed that fewer than 30% of HCWs reported previous training in isolation precautions.  While nurses scored highest on compliance with practices, all HCWs scored less than 50%.  And among physicians, researchers found both high knowledge scores and poor practices, suggesting negative attitudes, which have been shown to interfere with positive behavior change.

These studies point out the need for increased education for visitors, non-ICU HCWs and physicians regarding isolation precautions.  Equally important, researchers also emphasize the value of monitoring compliance and providing feedback within a facility to optimize success.

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