IPs save over $100,000 by using ... duct tape?

'Red Box' concept improves care of iso pts

OK, maybe duct tape really can fix everything. A simple red roll of this prime tool in the kit of every weekend repairman led to some rather startling results for innovative infection preventionists. The tape was used as an inexpensive solution to the costly and time-consuming problem of communicating with hospital patients who are isolated on contact precautions for infections at Trinity Medical Center in the Quad Cities on the Iowa/Illinois border.

The 504-bed Midwestern health system saved up to 2,700 hours in work time and $110,000 a year by creating a "Red Box" safe zone, a three-foot square of red duct tape extending from the threshold of the door, to facilitate communication with patients, said Janet Nau Franck, RN, MBA, CIC, an infection prevention consultant for the facility.

"The IP team noticed declining compliance of staff wearing gowns and gloves when entering an isolated patient's room," she said recently in Baltimore at the annual educational conference of the Association for Professionals in Infection Control and Epidemiology. "They also noted that staff was less likely to enter the room if they had to wear gowns and gloves. After some research and soul searching, they realized that no documented risk existed when communicating near the door's entrance. So they set out to the local hardware store, returning with red duct tape in hand."

By using this taped-off safe zone, the hospitals were able to save time, money in unused gowns and gloves, and improve the quality and frequency of communication between health care workers and isolated patients. Typically, workers must don personal protective equipment (PPE) before entering an isolated patient's room before any type of communication. Dressing in gowns and gloves before each interaction is time-consuming, costly and creates communication barriers with patients. Moreover, the hindrance of donning the equipment may be a disincentive for workers to enter the room.

"Once they cross out of the box then they are required to don the appropriate PPE — the gear is on the door," she explained. "They would wear gown and gloves if they step out of the red box into the patient's room. There is no documented evidence that there is any risk of transmission from the door. This study was evaluated for the use of contact precautions, but originally we were thinking it is certainly greater than three feet from the head of the patient bed. Realistically — although it was not studied — it could be used for droplet precautions."

The study showed that workers could safely enter the Red Box area without PPE for quick communication and assessment. At Trinity, approximately 30% of interactions with patients on contact precautions were performed in the box. In a worker survey, 67% of health care staff said that the approach lessened barriers when communicating with patients. Also, 79% reported that the box saved time in not having to put on and remove PPE. The same number said healthcare workers could assess and communicate with patients more easily. The box also serves as an additional visual cue to remind staff that they are entering an isolation room, which is usually only indicated by a sign outside the patient's room, she noted.

"It is a green initiative that saves money [in supplies] and also over 2700 hours — if you calculate it on an annual basis — which would exceed a fulltime equivalency of another staff person," Franck said.

Asked if such a program could be a proverbial slippery slope — introducing the idea that workers can enter an isolation room without PPE — Franck said compliance is assessed frequently in rounds. "The compliance has been about 98% and we are seeing that the staff is much happier because they don't always have to don the PPE."