Background:
The incidence of health care–associated infections is a significant cause of morbidity and a driver of excess costs in U.S. hospitals. Compliance with contact precautions is important in reducing transmission of multidrug‐resistant organisms (MDRO) such as methicillin‐resistant Staphylococcus aureus, vancomycin‐resistant Enterococcus, Clostridium difficile, and gram‐negative organisms producing extended‐spectrum β‐lactamases. In 2009, our institution added a new function to all computer‐based admission order sets, which prompted clinicians to assess each patient's history of MDRO and to order appropriate precautions. Although this new system improved early identification of patients at risk of transmitting MDRO, it was unclear how reliably the precautions were being implemented.
Methods:
Unannounced audits of all rooms at both sites of an urban university medical center with an active order for “contact precautions” were performed by a single investigator at random times on 11 days between November 2009 and March 2010. Adherence to the various components of the hospital's contact precautions policy (as defined below) was recorded. Compliance was defined as follows: (1) gloves in all sizes available in front of or inside the room, (2) gowns available within 3 doors in either direction of the room, (3) an unobstructed sink, (4) a functioning hand gel dispenser, (5) a dedicated stethoscope inside the patient room, and (5) a dedicated flashlight inside the patient room.
Results:
A total of 279 observations were recorded during the study period (24% from the intensive care unit). Compliance with the individual components of contact precautions was >90% except for the presence of dedicated stethoscopes (76%) and flashlights (61%). Stethoscopes and flashlights were available significantly more often in the intensive care unit (ICU) than on the wards (93% vs. 70% and 91% vs. 51%, respectively, P < 0.0001). Outside the ICU, compliance with stethoscopes and flashlights varied significantly between units. The range of compliance was 0%– 93% for stethoscopes and 0%–100% for flashlights.
Conclusions:
Despite an aggressive program to optimize physician ordering of contact precautions, provision of dedicated equipment was highly variable outside the ICU. However, some units, such as the bone marrow transplant unit, demonstrated high compliance with dedicated equipment standards, suggesting the presence of a remediable performance gap. Future directions will be to study and disseminate best practices from the high‐performing units throughout the hospital.
Disclosures:
A. Chadha ‐ none; F. Torriani ‐ none; B. Clay ‐ none; G. Seymann ‐ none