Getting pts in isolation, and keeping them there
Key program elements of a patient isolation program at the University of Chicago Medical Center include the following:
• Electronic flagging of infected patients: Each day, the microbiology laboratory sends a report to the hospital's infection control team listing patients with a positive culture for a multidrug resistant organism. Infection control practitioners enter an "isolation flag" into each patient's electronic medical record (EMR) indicating the need for contact precautions (assignment to a private room, placement of a contact isolation sign on the door, and use of a gown/gloves when entering the room). The system also identifies patients who tested positive during previous admissions and automatically flags their charts, thus eliminating the need for a physician order for isolation.
• Institution of contact precautions by anyone: Hospital policy allows any staff member (such as infection control practitioners and nurses) to initiate contact precautions based on the isolation flag, even without a physician's order. The typical process for implementing contact precautions is outlined below:
♦ Private room assignment: Admissions personnel responsible for patient room assignments (called bed desk attendants) assign flagged patients to a private room. The EMR does not allow the attendants to override an isolation flag, even if a physician's written orders do not include an isolation order. Patients whose subsequent cultures become positive during their hospital stay are moved to a private room if they are in a shared room.
♦ Nurse notification of isolation orders: When bed desk attendants telephone the unit charge nurse to inform him or her of the new admission or transfer, they also indicate the patient's need for contact precautions.
♦ Door sign placement: Nurses retrieve a preprinted green sign from a folder at the nursing station and place it on the patient's door. The sign indicates that all staff and visitors entering the room must wear a protective gown and gloves. The sign also reminds staff and visitors to remove their gown and gloves before exiting the room.
• Weekly rounding by infection control staff: Infection control staff conduct surveillance rounds on flagged patients every Tuesday (the same day they conduct their usual rounds) to make sure that they have been placed in a private room with the sign on the door. To assist with this task, infection control staff print a patient census that includes notes on the need for contact precautions (typically only a few patients on each unit require isolation). If a patient needing contact precautions has not been placed in a private room with the sign on the door, the rounding staff member talks with the patient's nurse to ensure such precautions are taken immediately, and provides general education about the importance of such precautions and how to find the isolation flag in the system.
• Educational posters to increase awareness: Posters explaining the importance of contact precautions and how to find the isolation flags hang on the walls of each hospital unit.
- Mawdsley EL, Garcia-Houchins S, Weber SG. Back to basics: Four years of sustained improvement in implementation of contact precautions at a university hospital. Jt Comm J Qual Patient Saf. 2010 Sep;36(9):418-23. [PubMed]