Contact precautions and a paradoxical question

Fewer visits, more washing on exit

Past research has linked contact precautions with adverse health events like patients developing delirium, increased risk of falls, or pressure ulcers.

Now we have a new study1 on the effects of contract precautions on patient care that poses something of a paradoxical question: Is it better to have fewer visits by health care workers who are much more likely to wash their hands upon exiting the isolated patient’s room? Maybe for the many, but not necessarily the one.

Over a 19-month period, researchers conducted a prospective cohort study observing health care worker activity at four acute-care hospitals in the United States where trained observers discreetly monitored health care worker activities during routine care using a standardized collection tool and fixed 1-hour observations periods.

Patients on contact precautions had 36% fewer visits from healthcare workers (2.78 visits/hour for patients on contact precautions and 4.37 visits/hour for those not on precautions). The difference was most evident among physicians and other providers, but less so in nurses. Importantly, healthcare workers were 16% more likely to perform hand hygiene upon exiting isolated patients’ rooms. The frequency of visitors was also impacted by contact precautions, with 23% fewer visitors for patients on precautions.

Reference

  1. Morgan DJ, Pineles L, Shardell M, et al. “The Effect of Contact Precautions on Healthcare Worker Activity in Acute Care Hospitals” Infect Control Hosp Epi 2013;33:69-73