Improving Contact Precautions Compliance on Bone Marrow Transplant ICU

Abstract

Infections caused by multi-drug resistant organisms (MDRO) have become increasingly prevalent in hospitals over the last decade. More than 70% bacteria that cause hospital-acquired infections are resistant to at least one drug commonly used to treat these infections. Contact precautions are important in preventing the spread of MDROs; however, compliance in intensive care units (ICU) is known to be low. Contact precautions compliance consists of hand hygiene before entering patient room and upon exiting patient room as well as utilizing gloves and gowns. Purpose: To assess if contact precaution compliance improves among Bone Marrow Transplant (BMT) ICU staff after providing education. Physicians and nursing staff completed a questionnaire assessing contact precaution knowledge prior to an oral educational offering. Contact precautions compliance audits utilizing the CDC MDRO form were performed three months using 30 observations per shift each month on a University hospital 16-bed BMT ICU. This tool evaluated compliance with hand washing on room entry and exit as well as gowning and gloving while in patient room. Staff were considered either compliant or noncompliant with the contact precautions as a whole. 70% of nursing staff and physicians completed assessment questionnaires with a mean score of 93.3%. Compliance with contact precautions was 14% at baseline, 36.6% first month, 61.7% second month, and 88.3% the third month. Staffing for acuity was also monitored. As acuity went down with improved staffing, contact precautions compliance went up. Contact precautions compliance gradually improved during the study as nurse and physicians became aware of audits - possibly a “Hawthorne Effect.” Compliance slowly improved while acuity was high; however, significant improvement was noted as acuity dropped. Improved contact precautions compliance was not believed to be education related. Additional studies are needed to evaluate the effect patient acuity and staffing have on contact precautions compliance.