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Epidemiology of Isolation Precautions

Published online by Cambridge University Press:  21 June 2016

Ann Pettinger  and
Mary D. Nettleman
Ann Pettinger
Affiliation:
Department of Nursing, The University of Iowa Hospitals and Clinics, Iowa City, Iowa
Mary D. Nettleman*
Affiliation:
Department of Internal Medicine, Division of General Medicine, Clinical Epidemiology, and Health Services Research, The University of Iowa Hospitals and Clinics, Iowa City, Iowa
*
University of Iowa Hospitals, C 41 GH, Iowa City, IA 52242
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Abstract

Objective:

To investigate compliance with isolation precautions.

Design:

A prospective observational study carried out during ten weeks of 1989. Participants were unaware of the study.

Setting:

The isolation bay of a 24-bed surgical intensive care unit in a 900-bed university tertiary care facility.

Participants:

Study participants included any healthcare worker or visitor entering the patient room during designated 15-minute intervals.

Results:

We observed 467 subjects entering patient rooms. Compliance with strict isolation (65%) was better than with wound/skin (40%) or excretion/secretion (36%) isolation (p<.01). Visitors were more compliant than healthcare workers (88% versus 41%; p<.01). Spending more time in the room was associated with improved compliance (p<.01). Compliance was higher for subjects entering with a group compared with those entering alone (51% versus 41%; p<.05). The compliance rate for nurses improved as the nurse/patient ratio improved (p= .14). Compliance was independent of severity of illness. Multivariate analysis revealed that the amount of time spent in the room, being a visitor, and use of strict isolation were independent predictors of compliance.

Conclusions:

Noncompliance was wide-spread. When increased demands are placed on the time of physicians and nurses in the name of cost containment, unperceived consequences, such as those resulting from decreased compliance, must be considered.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 12 , Issue 5 , May 1991 , pp. 303 - 307
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1991

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References

1. Centers for Disease Control. Guidelines for prevention of transmission of human immunodeficiency virus and hepatitis B virus to health-care and public-safety workers. MMWR. 1989;38:3–19.Google Scholar
2. Garner, JS, Simmons, JBI? Guidelines far the Prevention and Control of Nosocomial Infections. Atlanta, Ga: Centers for Disease Control; 1983.Google Scholar
3. Garner, JS, Favero, MS. Guidelines for handwashing and hospital environmental control. Section 1. Handwashing. In: Guidelines for the Prevention and Control of Nosocomial Infections. Atlanta, Ga: Centers for Disease Control; 1985:1–20.Google Scholar
4. Leclair, JM, Freeman, J, Sullivan, BE Crowley, CM, Goldmann, DA Prevention of nosocomial respiratory syncytial virus infections through compliance with glove and gown isolation precautions. N Engl J Med. 1987;317:329–334.Google Scholar
5. Klein, BS, Perloff, WH, Maki, DG. Reduction of nosocomial infection during pediatric intensive care by protective isolation. N Engl J Med. 1989;320:1714–1721.CrossRefGoogle ScholarPubMed
6. Larson, E. Compliance with isolation techniques. Am J Infect Control. 1983;11:221–225.Google Scholar
7. Albert, RK, Condie, E Hand-washing patterns in medical intensive-care units. N Engl J Med. 1981;304:1465–1466.Google Scholar
8. Graham, M. Frequency and duration of handwashing in an intensive care unit. Am J Infiction Control. 1990;18:77–81.CrossRefGoogle Scholar
9. Knaus, WA, Draper, EA, Wagner, DP, Wagner, DP, Zimmerman, JE. APACHE II. A severity of disease classification. Crit Care Med. 1985;13:818–829.CrossRefGoogle ScholarPubMed
10. Lemeshow, S, Teres, D, Pastides, H, Spitz-Avrunin, J, Steingrub, J. A method for predicting survival and mortality of ICU patients using objectively derived weights. Crit Care Med. 1985;13:519–525.10.1097/00003246-198507000-00001Google Scholar
11. Teres, D, Lemeshow, S, Spitz Avrunin, J, Pastides, H. Validation of the mortality prediction model for ICU patients. Crit Cure Med. 1987;15:208–213.CrossRefGoogle ScholarPubMed
12. Fleiss, JL. Statistical Methods for Rates and Proportions. New York, NY: Wiley & Sons; 1973.Google Scholar
13. Kleinhaum, DG, Kupper, LL, Muller, KE. Applied Regression Analysis and Other Multivariable Methods. 2nd ed. Boston, Mass: PWS-Kent Publishing Co.; 1988.Google Scholar
14. Statistical Methods for the Analysis of Biomedical Data. Woolson, RF, ed. New York, NY: John Wiley & Sons; 1987.Google Scholar
15. Mortimer, EA Jr. Lipsitz, PJ. Wolinsky, E. Ganzaga, Al. Rammelkamp, LH Jr. Transmission of staphylococci between newborns. Importance of the hands to personnel. Am J Dis Child. 1962;104:289–295.Google Scholar
16. Steere, AC, Mallison, GE Handwashing practices for the prevention of nosocomial infections. Ann Intern Med. 1975;83:683–690.Google Scholar
17. Reybrouch, G. Role of the hands in the spread of nosocomial infections. J Hosb Infect. 1983;4:103–110.10.1016/0195-6701(83)90040-3Google Scholar
18. Larson, E. A causal link between handwashing and risk of infection? Examination of the evidence. Infect Control Hosp Epidemiol. 1988;9:28–36.10.2307/30144131Google Scholar
19. Knittle, MA, Eitzman, DV, Bear, H. Role of hand contamination of personnel in the epidemiology of gram-negative nosocomial infections. J Pediatr. 1975;86:433–437.10.1016/S0022-3476(75)80980-2Google Scholar
20. Nauseef, WM, Maki, DG. A study of the value of simple protective isolation in patients with granulocytopenia. N Engl J Med. 1981;304:448–453.Google Scholar
21. Preston, GA, Larson, EL, Stamm, WE. The effect of private isolation rooms on patient care practices, colonization and infection in an intensive care unit. Am J Med. 1981;70:641–645.CrossRefGoogle Scholar
22. Shirani, KZ, McManus, AT, Vaughan, GM, McManus, WE Pruitt, BA Jr Mason, AD Jr. Effects of environment on infection in burn patients. Arch Surg. 1986;121:31–36.10.1001/archsurg.1986.01400010037003CrossRefGoogle ScholarPubMed
23. Burke, JF, Quinby, WC, Bendoc, CC, Sheehy, EM, Moreno, NC. The contribution of a bacterially isolated environment to the prevention of infection in seriously burned patients. Ann Surg. 1977;186:377–385.CrossRefGoogle Scholar
24. Murphy, D, Todd, JK, Chao, RK, Orr, I, McIntosh, K. The use of gowns and masks to control respiratory illness in pediatric hospital personnel. J Pediat. 1981;99:746–750.10.1016/S0022-3476(81)80401-5CrossRefGoogle ScholarPubMed
25. Donowitz, LG. Failure of the overgown to prevent nosocomial infection in a pediatric intensive care unit. Pediatrics. 1986;77:35–38.10.1542/peds.77.1.35Google Scholar
26. Hall, CB, Douglas, RG Jr. Nosocomial respiratory syncytial viral infections. Should gowns and masks be used? Am J Dis Child. 1981;135:512–515.Google Scholar
27. Agbayani, M, Rosenfeld, W, Evans, H, Salazar, D, Jhaveri, R, Braun, J.-Evaluation of modified gowning procedures in a neonatal intensive care unit. Am J Dis Child. 1981;135:650–652.Google Scholar
28. Lynch, P Jackson, MM, Cummings, MJ, ‘Stamm, WE. Rethinking the role of isolation practices in the prevention of nosocomial infections. Ann Intern Med. 1987;107:243–246.CrossRefGoogle ScholarPubMed
29. Doebbeling, BN, Pfaller, MA, Houston, AK, Wenzel, RP. Removal of nosocomial pathogens from the contaminated glove. Ann Intern Med. 1988;109:394–398.10.7326/0003-4819-109-5-394Google Scholar
30. Haque, KN, Changla, AH. Do gowns prevent infection in neonatal intensive care units? J Hosp Infect. 1989;14:159–162.CrossRefGoogle ScholarPubMed
31. Hawthorne studies. In: Mitchel, J, Stein, J, eds. The Random House Encylopedia. New York, NY: Random House; 1983:2262.Google Scholar
32. Haley, RW, Hooton, TM, Culver, DH, Stanley, AC, Emori, G. Nosocomial infections in U.S. hospitals, 19751976. Am J Med. 1981;70:947–959.Google Scholar
33. Donowitz, GR Infection prevention in the compromised host. In: Wenzel, W, ed. Prevention and Control of Nosocomial Infections. Philadelphia, Penn: Williams & Wilkins; 1987.Google Scholar
34. Donowitz, LG, Wenzel, RP, Hoyt, JW. High risk of hospital-acquired infection in the ICU patient. Crit Care Med. 1982;10:355–357.CrossRefGoogle ScholarPubMed
35. Wenzel, RP, Thompson, RL, Landry, SM, et al. Hospital-acquired infections in intensive care unit patients: an overview with emphasis on epidemics. Infect Control. 1983;4:371–375.Google Scholar
36. Schimpff, SC, Miller, RM, Polakavetz, S, Hornick, RB. Infection in the severely traumatized patient. Ann Surg. 1974;179:352–357.Google Scholar
37. Curran, CR, Minnick, A, Moss, J. Who needs nurses? Am J Nurs. 1987;87:444–447.Google ScholarPubMed
38. Department of Health and Human Services. The registered nurse population, 1984. Springfield, Va: National Technical Information on Service. DHHS Publication No. HRP 0906938; 1986.Google Scholar
39. American Hospital Association. Nurse vacancy rates. Analysis from the 1982-1985 Annual Survey. Chicago, Ill: American Hospital Association; 1986.Google Scholar
40. Haley, RW, Bregman, DA. The role of understaffing and over-crowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit. J Infect Dis. 1982;145:875–885.Google Scholar
41. Dixon, RE. Costs of nosocomial infections and benefits of infection control programs. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. Baltimore, MD: Williams & Wilkins: 1987:19–25.Google Scholar