Rightsizing Isolation for the Acute Rehabilitation Setting

Abstract

Issue: We are an Acute Rehabilitation Hospital, serving stroke, brain injury, orthopedic and spinal cord injury patients. Implementing Contact Precautions according to CDC recommendations did not work for our setting, since patients spend most of the day out of the room receiving therapy in a communal gym setting. We compromised, allowing MDRO colonized patients on Contact Precautions to attend therapy, implementing Contact Precautions only when the patients returned to the room. Patients on ABX for MDRO infections were required to remain in their rooms on Contact Precautions for the duration of antibiotic therapy. These compromises negatively impacted the type and amount of therapy patients received. Additionally, staff were concerned that patients were isolated too long, and that isolation was ineffective when done only when the patient was in the room. This set up cognitive dissonance for staff; they became resistant to complying with Contact Precautions.