Contact precautions for multidrug-resistant organisms: Current recommendations and actual practice

Background

Contact precautions are recommended for interactions with patients colonized/infected with multidrug-resistant organisms; however, actual rates of implementation of contact precautions are unknown.

Methods

Observers recorded the availability of supplies and staff/visitor adherence to contact precautions at rooms of patients indicated for contact precautions. Data were collected at 3 sites in a New York City hospital network.

Results

Contact precautions signs were present for 85.4% of indicated patients. The largest proportions were indicated for isolation for vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus cultures. Isolation carts were available outside 93.7% to 96.7% of rooms displaying signs, and personal protective equipment was available at rates of 49.4% to 72.1% for gloves (all sizes: small, medium, and large) and 91.7% to 95.2% for gowns. Overall adherence rates on room entry and exit, respectively, were 19.4% and 48.4% for hand hygiene, 67.5% and 63.5% for gloves, and 67.9% and 77.1% for gowns. Adherence was significantly better in intensive care units (P < .05) and by patient care staff (P < .05), and patient care staff compliance with one contact precautions behavior was predictive of adherence to additional behaviors (P < .001).

Conclusions

Our findings support the recommendation that methods to monitor contact precautions and identify and correct nonadherent practices should be a standard component of infection prevention and control programs.

Key Words: Contact precautions, adherence, isolation, antimicrobial resistance, compliance