Poster 159: Contact precautions in a rehabilitation hospital.

Abstract

Objectives: To develop a modification of the US Centers for Disease Control and Prevention (CDC) contact precautions applicable to the rehabilitation environment and to determine its impact on implementation and nosocomial infection rates of specific pathogens. Design: Descriptive epidemiologic study. Setting: 110-bed free-standing comprehensive inpatient rehabilitation teaching hospital. Participants: All hospital staff and inpatients. Interventions: An infection prevention program, based on CDC contact precautions directed at Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE), was implemented. This program incorporated the following elements: new definitions for stop and start of precautions; establishment of criteria for private rooms and protective equipment utilization; institution of precautions within therapy departments; emphasis on housekeeping for prevention of environmental contamination; initiation of door-mounted isolation supplies; implementation of alcohol-based waterless hand hygiene; staff education; computer tracking of patients in isolation; surveillance of isolation implementation and compliance; and selective use of eradication therapy. Main Outcome Measures: The ability of staff to comprehend, implement, and adhere to the prevention program; efficiency in isolation resource utilization; and nosocomial rates for Clostridium difficile, MRSA, and VRE. Results: Staff demonstrated better understanding of precaution implementation and improved compliance with more reliable private room and protective equipment use. There was less disruption of the rehabilitation process. During the first year of program phase-in, the percentage of nosocomial infections decreased as follows: Clostridium difficile, 48.7%; MRSA, 69.5%; and VRE, 64.1%. Conclusion: We present a modification of the CDC contact precautions implementation specific for the rehabilitation environment that is more easily understood, more consistently and effectively implemented by staff, and that effectively prevents nosocomial transmission of epidemiologically important pathogens.