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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3026 — Contact Isolation for Infection Prevention and Decreased Healthcare Worker Attention: A Quality Concern?

Morgan DJ, Baltimore VAMC; Forrest G, Portland VAMC; Graham M, Iowa City VAHCS; Pineles L, Baltimore VAMC; Shardell M, University of Maryland, Baltimore; Schweizer M, Iowa City VAHCS; Young A, Baltimore VAMC; Mogammadi S, Portland VAMC; Perencevich EN, Iowa City VAHCS;

Isolation of patients is a key intervention for infection control and the VA MRSA Prevention Initiative. However, the isolation of patients has been associated with approximately half as many visits from healthcare workers, and this is postulated to lead to more depression and adverse events. We aimed to measure the association between patient isolation status and frequency and duration of healthcare worker visits.

We conducted a prospective cohort study of healthcare worker behavior over 11 acute care units at the Baltimore VA Medical Center, Iowa City VA Medical Center, and Portland VA Medical Center. Unidentified (secret) observers monitored all room entries during one-hour periods at randomly determined rooms. They counted number and duration of each visit and monitored hand hygiene compliance using standard methods.

From 3/1/2011 to 7/22/2011 we recorded 1157 hours of observation. Frequency of healthcare worker visits was less in patients in isolation, 2.95 per hour vs. 4.61 per hour, p = 0.003. Total healthcare worker time in patient rooms of isolated patients was 18% less than non-isolated patients (15.1 minutes/hour in patients on isolation and 18.4 minutes in patients not isolated, p = 0.15). Patients on isolation had an outside visitor 22.2% of the time compared to 26.9% in patients not isolated (p = 0.58). Healthcare worker hand hygiene was higher in isolation rooms. At room exit, 58.1% of healthcare workers performed hand hygiene after caring for patients on isolation vs. 42.3% of healthcare workers performing hand hygiene after caring for patients not on isolation (p <0.001). However, entry compliance was the same in isolated and non-isolated rooms, p = 0.32.

Across 3 VA Medical Centers, we found healthcare workers were less likely to visit patients on isolation and that overall time with patients was also decreased. Patients on isolation were also slightly less likely to be visited by family members. Conversely, hand hygiene was improved when caring for patients on isolation.

Isolation precautions lead to less contact with healthcare workers. This may be the mechanism by which isolation leads to more adverse events. Further attention is warranted to determine if patients on isolation receive worse care.

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