There’s an interesting study in the March issue of Infection Control and Hospital Epidemiology led by Keith Kaye, which examines the hypothesis that the burden of patients in contact precautions has an impact on compliance with contact precautions. The study used surreptitious observers to record compliance with the components of contact precautions in eleven teaching hospitals. Approximately 1,000 observations were performed in the ICU and ward settings. The authors conclude: ”As the proportion of patients in contact isolation increases, compliance with contact isolation precautions decreases.”
However, looking at the same data, I came to a different conclusion. I converted the bar graph (figure 2 in the paper) to a line graph which makes it easier to follow compliance with each component of contact precautions as the proportion of patients in contact precautions increases:
Now you can clearly see that the only problem with compliance as the burden of contact precautions increased was with hand hygiene prior to donning of gowns and gloves. Thus, decreased compliance with the contact precautions “bundle” was driven solely by the decrease in hand hygiene prior to patient contact.
It has been shown in other studies that hand hygiene is lower prior to contact precautions. And I think there is a very simple reason that this occurs: you can’t get the gloves on until your hands are completely dry. Hand hygiene before and after patient contact is an essential component of standard precautions. What sets contact precautions apart from standard precautions is the use of gowns and gloves, and the data in this study show no decrease in gown or glove use as the proportion of patients in contact precautions increases. In addition, the overall usage of gowns and gloves was surprisingly high.
So my conclusion would be that there is a negative correlation between the burden of contact precautions and hand hygiene prior to patient care. And maybe that’s not so bad.
Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. This post originally appeared at the blog Controversies in Hospital Infection Prevention.