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Transcript of PICO Presentation
Lisa Weber PICO Presentation non-compliance with healthcare providers and families
can put other patients at risk for the contraction of nosocomial infection
can spread the infection to anyone who is in contact with infected patients The Problem Port The Whirlpool of Decision Protocol Volcano Evidencia Skullastica "X-Marks the PICO"
Mercy/JCAHO Policy OUR PICO QUESTION:
For patients with a contagious/communicable infection, does the compliance of contact precautions greatly reduce the risk of spreading the infection to others compared to non-compliance of contact precautions? types of precautions
droplet we have often witnessed staff and family members not following proper isolation precautions
many times, the nurse or physician will not take the time to "gown and glove" before entering the room
without infection control, people can acquire serious infections that can be prevented "routine gowning for contact isolation of all intubated patients would cost the SICU an additional $55,000/yr in gown costs alone" Kaitlyn: "To Gown or Not to Gown..."
study was done in BJC, St. Louis
purpose: “to determine whether enteric VRE acquisition rates were affected when gowns were & were not a component of contact precautions for interaction with patients infected or colonized with VRE in a medical intensive care unit (MICU)”
18 mths of gown/glove use; 12 mths of just glove use
VRE acquistion rates = 9.0 cases/1000 MICU days in both gown periods; 19.6 cases/1000 MICU days in no-gown period
conclusion: GOWNS DO HAVE PROTECTIVE EFFECT; however, "it is difficult to determine whether gowns provide a direcct, physical barrier to reduce VRE transmission or whether gowns provide an indirect effect by enhancing compliance with infection-control procedures" Lisa: "Compliance with Isolation Precautions at a University Hospital"
1. study conducted at University of North Carolina Hospitals
2. 688 beds and 38 nursing units
3. purpose - “to assess compliance with current isolation precautions, guidelines, and infection control”
4. results – overall, the observed rate of compliance with isolation precaution guidelines, by type of isolation precaution, was in the range of 60%-70%.
Type of isolation Compliance rate
(# Of rooms compliant/total)
Droplet 100% (4/4)
Airborne 61.5% (8/13)
Contact 73.3% (120/165)
Protective 73.6% (53/72)
9. Conclusion - observations suggest that healthcare workers are not fully compliant with guidelines for proper use of personal protective equipment and the proper maintenance of the physical environment. The study also suggests that the visitors are much more noncompliant than healthcare workers.
10. “Failure to adhere to proper isolation precautions for patients with communicable diseases may lead to transmission of diseases to healthcare workers, visitors, and other patients”.
11. Healthcare facilities should stress the need for compliance with CDC-recommended isolation precautions, targeting visitors in particular Kristin: "Multi-Drug Resistant Bacteria Infection Control..."
1. pts hospitalized for more than 48 hrs, identified with MRSA
2. RNs graduates qualified for technical care; care assistants provide nursing care and assistant nurses; physicians were included regardless of position in hospital; only practices of first caregiver entering patient’s room were observed for each category of personnel
3. contact defined as every direct contact with pt or indirect contact with environmental surfaces or pt care equipment
4. main issues – (1) physicians writing order for isolation, (2) appropriate placement of pts, (3) protective equipment availability, (4) notification of MRSA status in cases of transfer between units; absence of written order and of record in nursing chart were associated with poor compliance in isolation precaution practices
a. compliance with isolation precautions was better in ICU than in other care units; staff of ICU appeared more concerned about infection control practice than staff of other units, possibly because infections are more frequent and severe in these units than in others
b. improving compliance of physicians and care assistants with isolation precautions practices are important Jaclyn: "Isolation Precautions for MRSA..."
Health care professionals adherence to national isolation precautions have been found to be inadequate
study conducted in a 900 bed hospital
researchers reported that an infectious control physician and an ICU pharmacist made 1548 observations that involved 2110 individuals entering the room of a patient in isolation
this number included 1504 staff members and 606 visitors. 73% complied with use of gowns, including 67% physicians and 78% of nurses
in regression analyses independent predictors of gown compliance among staff were female sex and ICU setting
staff members were unaware they were being observed.
the researchers believe a surveillance system will help decrease spread of infection though it is not a required precaution
methods of surveillance are direct observation, remote observation, self-report, volume of products used, electronic monitoring, and health care-associated infection rates Shiphie: "Comparison of Routine Glove Use..."
1. purpose: to compare routine glove use by healthcare professionals for all residents
2. 18-mth study; skilled-care unit of 667 bed acute- and long-term care facility; all residents participated in 18-mth study
3. study took place at Oak Forest Hospital – any pts with known VRE or MRSA were placed on contact-isolation precautions; gowns and gloves available, residents placed in private/cohort rooms; however, residents were not confined to their rooms, not routinely screened for determination of colonization status; also, no specific recommendations for residents if they were positive in these tests
4. to detect MRSA – naris, rectum, gastrostomy-tube site, and skin breakdown areas; also used to detect VRE, E. coli, and Klebsiella
5. case pts defined as residents who acquired study organism; if they had one organism, they were eligible for other study organisms
6. at time of swab collection, several factors were collected; hand hygiene and glove use was also observed
7. gown use was estimated by counting the amount of gowns used at beginning to end of shift for three pt cases
a. residents of routine glove use section were significantly more likely to be culture-positive for E coli on initial swab
b. 15 gowns per resident per day; gown costs would be greater if used more than present
c. 700 additional boxes of gloves/yr were estimated; glove costs would also be greater if used more than present
9. several possible limitations to use of contact-isolation precautions in LTCFs, such as lack of efficacy, personnel and material costs, risk of transmission, possible exclusion from group social activities
10. conclusion: routine glove use for healthcare workers may be preferable in many long-term care facilities Jackie: "Infection Control measures to limit the spread of C diff"
1. Clostridium Difficile-associated diarrhea (CDAD) presents mainly asvnosocomial infection, usually after antimicrobial therapy; leading cause of intestinal infections; many outbreaks- attributed to C-diff, causing a more severe disease and worsened patient outcomes
2. Direct /indirect contact represents main route of C-diff, as spores may persist in environment for months/years; shows resistance to various environmental cleaners (ie detergents, some disinfectants), which is why we use isolation precautions
3. Outbreaks- 36 outbreaks caused by C-difficile were filed in the outbreak database in a local hospital in Hannover Germany. 19 - route of transmission could not be determined/was not described by authors
17 - pathogen spread occurred ‘by contact’ via carriage of spores on hands of staff, by pt to pt spread, or indirectly from the contaminated environment
4. So what can hospitals do better to prevent this?
a. most important - the use of isolation precautions!b. patient is preferably nursed in single bedded room with dedicated equipment, PPE (including gowns and gloves)
c. Isolation of patients with infectious agents in single rooms/cohorts = basic hygiene measure of contact isolation, which limits pathogen spread
d. re-isolation of patients presenting with diarrhea at a subsequent readmission may reduce the occurrence of new nosocomial CDAD cases
e. critical issue - how long isolation & other control measures need to be continued. Even after adequate therapy for CDAD & return to normal bowel movements, patients may still have detectable C. diff toxins in feces and continue to excrete C. diff
5. Other recommendations for preventing the spread of C. diff-
a. Screening cultures to identify carriers of pathogens at an early stage before cross transmission
b. Surveillance- detects an increase in CDAD incidence and severity at an early stage
c. Hand Hygiene
d. Education and communication
e. Environmental cleaning types of infections/diseases:
methicillin-resistant Staph aureus (MRSA), VRE
•Gown when entering room
•Gloves to enter room
•Remove PPE before leaving room
•Strict handwashing/hand hygiene
•Clean equipment before removing it from room
•Teach patient/family "the point of isolation is to isolate the infectious organism so that it is not transferred to anyone else"
"the most common mode of transmission...direct contact, often on the hands of healthcare workers"
"contact precautions...are taken to prevent the transmission of infections spread by direct contact with patients..."
"it is desirable...to be nursed in single rooms becasuse the surrounding surfaces are liekly to become heavily contaminated"
"good communication is necessary with all visitors and staff, including cleaners...everyone who is likely to have contact with the patient...is entitled to know how to reduce the risks of infection to themselves...should be aware of actions they must take to prevent spreading it to others