Compliance With Routine Use of Gowns by Healthcare Workers (HCWs) and Non-HCW Visitors on Entry Into the Rooms of Patients Under Contact Precautions

2007 ◽  
Vol 28 (3) ◽  
pp. 337-340 ◽  
Author(s):  
Farrin A. Manian ◽  
John J. Ponzillo
Keyword(s):  
Healthcare Workers ◽  
Prospective Observational Study ◽  
Community Hospital ◽  
Medical Center ◽  
Tertiary Care ◽  
Contact Precautions ◽  
Teaching Community ◽  
Direct Exposure ◽  
General Wards ◽  
The Relationship

Background.Modified contact precautions (MCP), defined as routine donning of isolation gowns (along with routine gloving) on entry into the rooms of patients under contact precautions, regardless of the likelihood of direct exposure to the patient or their immediate environment, were instituted at our medical center to reduce nosocomial transmission of common hospital pathogens.Objectives.To study compliance with MCP policy regarding routine gowning in intensive care units (ICUs) and general wards and to determine the relationship between gown and glove use in the care of patients under MCP in ICUs.Design.Prospective observational study from February 20, 2004, through January 8, 2005, involving 2,110 persons (1,504 healthcare workers [HCWs] and 606 non-HCW visitors).Setting.A 900-bed tertiary care teaching community hospital.Results.Overall compliance with routine gown use was observed for 1,542 persons (73%), including 1,150 HCWs (76%) and 392 visitors (65%) (odds ratio [OR], 1.8 [95% confidence interval {CI}, 1.4-2.2]; P < .001). Visitors in the ICUs (186 [91%] of 204) were more likely than visitors in the general wards (202 [51%] of 398) to comply with gown use (OR, 10 [95% CI, 6.0-17.0]; P < .001). In logistic regression analysis, independent predictors of gown compliance among HCWs were female sex (OR, 2.3 [95% CI, 1.8-3.0]; P < .001) and ICU setting (OR, 2.2 [95% CI, 1.7-2.9]; P < .001). In the ICUs, gown use was highly predictive of glove use among HCWs (positive predictive value, 95%).Conclusion.Improvement in compliance with gown use at our medical center will require more-intensive educational efforts targeted at male HCWs and at HCWs and visitors on general wards. In the care of ICU patients under MCP, HCW compliance with gown use may be used as a proxy for their compliance with glove use.

Nosocomial Acquisition of Methicillin-ResistantStaphylococcus aureusDuring an Outbreak of Severe Acute Respiratory Syndrome

2005 ◽  
Vol 26 (2) ◽  
pp. 134-137 ◽  
Author(s):  
Susan M. Poutanen ◽  
Mary Vearncombe ◽  
Allison J. McGeer ◽  
Michael Gardam ◽  
Grant Large ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Infection Control ◽  
Retrospective Cohort ◽  
Healthcare Workers ◽  
Community Hospital ◽  
Tertiary Care ◽  
Appropriate Use ◽  
Contact Precautions ◽  
Control Education ◽  
Tertiary Care Hospitals

AbstractObjective:The four hospitals assessed in this study use active surveillance cultures for methicillin-resistantStaphylococcus aureus(MRSA) and contact precautions for MRSA-positive patients as part of routine infection control practices. The objective of this study was to determine whether nosocomial acquisition of MRSA decreased in these hospitals during an outbreak of severe acute respiratory syndrome (SARS) when barrier precautions were routinely used for all patients.Design:Retrospective cohort study.Setting:Three tertiary-care hospitals (a 1,100-bed hospital; a 500-bed hospital; and an 823-bed hospital) and a 430-bed community hospital, each located in Toronto, Ontario, Canada.Patients:All admitted patients were included.Results:The nosocomial rate of MRSA in all four hospitals combined during the SARS outbreak (3.7 per 10,000 patient-days) was not significantly different from that before (4.7 per 10,000 patient-days) or after (3.4 per 10,000 patient-days) the outbreak (P= .30 andP= .76, respectively). The nosocomial rate of MRSA after the outbreak was significantly lower than that before the outbreak (P= .003). Inappropriate reuse of gloves and gowns and failure to wash hands between patients on non-SARS wards were observed during the outbreak. Increased attention was paid to infection control education following the outbreak.Conclusions:Inappropriate reuse of gloves and gowns and failure to wash hands between patients may have contributed to transmission of MRSA during the SARS outbreak. Attention should be paid to training healthcare workers regarding the appropriate use of precautions as a means to protect themselves and patients.

scholarly journals 421. Effect of SARs-Cov-2 mRNA Vaccination in Healthcare Workers with Household COVID Exposure

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S311-S311
Author(s):  
Laura Selby ◽  
Richard Starlin
Keyword(s):  
Healthcare Workers ◽  
Screening Program ◽  
Medical Center ◽  
Severe Disease ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Limited Data ◽  
Viral Shedding ◽  
Academic Medical ◽  
Significant Burden

Abstract Background Healthcare workers have experienced a significant burden of COVID-19 disease. COVID mRNA vaccines have shown great efficacy in prevention of severe disease and hospitalization due to COVID infection, but limited data is available about acquisition of infection and asymptomatic viral shedding. Methods Fully vaccinated healthcare workers at a tertiary-care academic medical center in Omaha Nebraska who reported a household exposure to COVID-19 infection are eligible for a screening program in which they are serially screened with PCR but allowed to work if negative on initial test and asymptomatic. Serial screening by NP swab was completed every 5-7 days, and workers became excluded from work if testing was positive or became symptomatic. Results Of the 94 employees who were fully vaccinated at the time of the household exposure to COVID-19 infection, 78 completed serial testing and were negative. Sixteen were positive on initial or subsequent screening. Vaccine failure rate of 17.0% (16/94). Healthcare workers exposed to household COVID positive contact Conclusion High risk household exposures to COVID-19 infection remains a significant potential source of infections in healthcare workers even after workers are fully vaccinated with COVID mRNA vaccines especially those with contact to positive domestic partners. Disclosures All Authors: No reported disclosures

A Prolonged Outbreak of Methicillin-Resistant Staphylococcus aureus in the Burn Unit of a Tertiary Medical Center

1996 ◽  
Vol 17 (12) ◽  
pp. 798-802 ◽  
Author(s):  
Patricia A. Meier ◽  
Cheryl D. Carter ◽  
Sarah E. Wallace ◽  
Richard J. Hollis ◽  
Michael A. Pfaller ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infection Control ◽  
Healthcare Workers ◽  
Medical Center ◽  
Tertiary Care ◽  
Chromosomal Dna ◽  
Methicillin Resistant ◽  
Persistent Problem ◽  
Tertiary Care Medical Center ◽  
Burn Unit

AbstractObjective:To report an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in our burn unit and the steps we used to eradicate the organism.Design And Setting:Outbreak investigation in the burn unit of a 900-bed tertiary-care medical center.Outbreak:Between March and June 1993, MRSA was isolated from 10 patients in our burn unit. All isolates had identical antibiograms and chromosomal DNA patterns.Control Measures:Infection control personnel encouraged healthcare workers to wash their hands after each patient contact. The unit cohorted all infected or colonized patients, placed each affected patient in isolation, and, if possible, transferred the patient to another unit. Despite these measures, new cases occurred. Infection control personnel obtained nares cultures from 56 healthcare workers, 3 of whom carried the epidemic MRSA strain. One healthcare worker cared for six affected patients, and one cared for five patients. We treated the three healthcare workers with mupirocin. Subsequently, no additional patients became colonized or infected with the epidemic MRSA strain.Conclusions:The outbreak ended after we treated healthcare workers who carried the epidemic strain with mupirocin. This approach is not appropriate in all settings. However, we felt it was justified in this case because of a persistent problem after less intrusive measures.

scholarly journals Detection of Methicillin-ResistantStaphylococcus aureusand Vancomycin-Resistant Enterococci on the Gowns and Gloves of Healthcare Workers

2008 ◽  
Vol 29 (7) ◽  
pp. 583-589 ◽  
Author(s):  
Graham M. Snyder ◽  
Kerri A. Thorn ◽  
Jon P. Furuno ◽  
Eli N. Perencevich ◽  
Mary-Claire Roghmann ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Medical Center ◽  
Tertiary Care ◽  
Routine Care ◽  
Inpatient Setting ◽  
Jejunostomy Tube ◽  
Endoscopic Gastrostomy ◽  
Vancomycin Resistant Enterococci ◽  
Increased Risk ◽  
Vancomycin Resistant

Objective.To assess the rate of and the risk factors for the detection of methicillin-resistantS. aureus(MRSA) and vancomycin-resistant enterococci (VRE) on the protective gowns and gloves of healthcare workers (HCWs).Methods.We observed the interactions between HCWs and patients during routine clinical activities in a 29-bed medical intensive care unit at the University of Maryland Medical Center, an urban tertiary care academic hospital. Samples for culture were obtained from HCWs' hands prior to their entering a patient's room, from HCWs' disposable gowns and gloves after they completed patient care activities, and from HCWs' hands immediately after they removed their protective gowns and gloves.Results.Of 137 HCWs caring for patients colonized or infected with MRSA and/or VRE, 24 (17.5%; 95% confidence interval, 11.6%–24.4%) acquired the organism on their gloves, gown, or both. HCW contact with the endotracheal tube or tracheostomy site of a patient (P< .05), HCW contact with the head and/or neck of a patient (P< .05), and HCW presence in the room of a patient with a percutaneous endoscopic gastrostomy and/or jejunostomy tube (P< .05) were associated with an increased risk of acquiring these organisms.Conclusions.The gloves and gowns of HCWs frequently become contaminated with MRSA and VRE during the routine care of patients, and particularly during care of the patient's respiratory tract and any associated indwelling devices. As part of a larger infection control strategy, including high-compliance hand disinfection, they likely provide a useful barrier to transmitting antibiotic-resistant organisms among patients in an inpatient setting.

Patterns in Patient Safety with Computerized Consult Management and Clinical Documentation

2014 ◽  
Vol 3 (1) ◽  
pp. 134-141
Author(s):  
Jason J. Saleem ◽  
Richard M. Frankel ◽  
Bradley N. Doebbeling ◽  
Emily S. Patterson
Keyword(s):  
Patient Safety ◽  
Healthcare Workers ◽  
Medical Center ◽  
Tertiary Care ◽  
Clinical Information ◽  
Clinical Documentation ◽  
Unit Of Analysis ◽  
Safety Issues ◽  
Inpatient Ward ◽  
Units Of Analysis

Patient safety issues continue to be prevalent in delivering care with the electronic health record (EHR) and other health information technology (HIT) tools. Defining the unit of analysis for the study of clinical information systems is important based on the focus of the research. This study applies a conceptual framework with three levels of units of analysis for human-computer interaction (HCI) to identify and guide investigations at each level. Ethnographic observations and semi-structured, key-informant interviews were conducted with 40 healthcare workers across five primary care clinics, nine specialty clinics, and one inpatient ward at a tertiary-care Veterans Affairs Medical Center (VAMC). Two researchers recorded the interactions and interview responses of 40 healthcare workers related to their work with computerized consultations, clinical documentation, and the EHR in general. Patient safety issues from these data were categorized using three different units of analysis: EHR interface-, team coordination / workflow-, and organizational-levels. A total of 30 patient safety issues were identified; 17 emerged from the observation and interview data on computerized consults, 10 from the data on clinical documentation, and 3 were related to the EHR in general. Patient safety issues were organized by level of unit of analysis and mapped to specific methods that could be used for further investigation. Relevant concepts are discussed to help guide investigations at each level.

scholarly journals Impact of Bordetella pertussis Exposures on a Massachusetts Tertiary Care Medical System

2007 ◽  
Vol 28 (6) ◽  
pp. 708-712 ◽  
Author(s):  
Iva Zivna ◽  
Diana Bergin ◽  
Joanne Casavant ◽  
Sally Fontecchio ◽  
Susan Nelson ◽  
...  
Keyword(s):  
Bordetella Pertussis ◽  
Healthcare Workers ◽  
Close Contact ◽  
Medical Center ◽  
Tertiary Care ◽  
Medical System ◽  
Secondary Case ◽  
Tertiary Care Medical Center ◽  
Outbreak Investigations ◽  
The Impact

Objective.To assess the impact of outbreaks of Bordetella pertussis infection on a tertiary care medical system.Design.Retrospective study.Setting.Academic tertiary care medical center and affiliated ambulatory care settings.Subjects.All patients and healthcare workers (HCWs) who were in close contact with patients with laboratory-confirmed cases of B. pertussis infection from October 1, 2003, through September 30, 2004.Intervention.Direct and indirect medical center costs were determined, including low and high estimates of time expended in the evaluation and management of exposed patients and HCWs during outbreak investigations of laboratory-confirmed cases of B. pertussis infection.Results.During this period, 20 primary and 3 secondary laboratory-confirmed cases of B. pertussis infection occurred, with 2 primary pertussis cases and 1 secondary case occurring in HCWs. Outbreak investigations prompted screening of 353 medical center employees. Probable or definitive exposure was identified for 296 HCWs, and 287 subsequently received treatment or prophylaxis for B. pertussis infection. Direct medical center costs for treatment and prophylaxis were $13,416 and costs for personnel time were $19,500-$31,190. Indirect medical center costs for time lost from work were $51,300-$52,300. The total cost of these investigations was estimated to be $85,066-$98,456.Conclusions.Frequent B. pertussis exposures had a major impact on our facility. Given the impact of exposures on healthcare institutions, routine vaccination for HCWs may be beneficial.

scholarly journals Relationship between Chlorhexidine Gluconate Skin Concentration and Microbial Density on the Skin of Critically Ill Patients Bathed Daily with Chlorhexidine Gluconate

2012 ◽  
Vol 33 (9) ◽  
pp. 889-896 ◽  
Author(s):  
Kyle J. Popovich ◽  
Rosie Lyles ◽  
Robert Hayes ◽  
Bala Hota ◽  
William Trick ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Medical Intensive Care Unit ◽  
Medical Center ◽  
Chlorhexidine Gluconate ◽  
Gram Positive ◽  
Microbial Density ◽  
Medical Intensive Care ◽  
Skin Cleansing ◽  
The Relationship

Objective and Design.Previous work has shown that daily skin cleansing with Chlorhexidine gluconate (CHG) is effective in preventing infection in the medical intensive care unit (MICU). A colorimetric, semiquantitative indicator was used to measure CHG concentration on skin (neck, antecubital fossae, and inguinal areas) of patients bathed daily with CHG during their MICU stay and after discharge from the MICU, when CHG bathing stopped.Patients and Setting.MICU patients at Rush University Medical Center.Methods.CHG concentration on skin was measured and skin sites were cultured quantitatively. The relationship between CHG concentration and microbial density on skin was explored in a mixed-effects model using gram-positive colony-forming unit (CFU) counts.Results.For 20 MICU patients studied (240 measurements), the lowest CHG concentrations (0–18.75 μg/mL) and the highest gram-positive CFU counts were on the neck (median, 1.07 log10CFUs;P= .014). CHG concentration increased postbath and decreased over 24 hours (P< .001). In parallel, median log10CFUs decreased pre- to postbath (0.78 to 0) and then increased over 24 hours to the baseline of 0.78 (P= .001). A CHG concentration above 18.75 μg/mL was associated with decreased gram-positive CFUs (P= .004). In all but 2 instances, CHG was detected on patient skin during the entire interbath (approximately 24-hour) period (18 [90%] of 20 patients). In 11 patients studied after MICU discharge (80 measurements), CHG skin concentrations fell below effective levels after 1–3 days.Conclusion.In MICU patients bathed daily with CHG, CHG concentration was inversely associated with microbial density on skin; residual antimicrobial activity on skin persisted up to 24 hours. Determination of CHG concentration on the skin of patients may be useful in monitoring the adequacy of skin cleansing by healthcare workers.

scholarly journals Depression, Anxiety, and Moods of Hospitalized Patients under Contact Precautions

2013 ◽  
Vol 34 (3) ◽  
pp. 251-258 ◽  
Author(s):  
Hannah R. Day ◽  
Eli N. Perencevich ◽  
Anthony D. Harris ◽  
Ann L. Gruber-Baldini ◽  
Seth S. Himelhoch ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Medical Center ◽  
Tertiary Care ◽  
Depression Scale ◽  
Care Hospital ◽  
University Of Maryland ◽  
Contact Precautions ◽  
Symptoms Of Depression ◽  
Mood Scale ◽  
The University

Objective.To determine the association between contact precautions and depression or anxiety as well as feelings of anger, sadness, worry, happiness, or confusion.Design.Prospective frequency-matched cohort study.Setting.The University of Maryland Medical Center, a 662-bed tertiary care hospital in Baltimore, Maryland.Participants.A total of 1,876 medical and surgical patients over the age of 18 years were approached; 528 patients were enrolled from January through November 2010, and 296 patients, frequency matched by hospital unit, completed follow-up on hospital day 3.Results.The primary outcome was Hospital Anxiety and Depression Scale (HADS) scores on hospital day 3, controlling for baseline HADS scores. Secondary moods were measured with visual analog mood scale diaries. Patients under contact precautions had baseline symptoms of depression 1.3 points higher (P < .01) and anxiety 0.8 points higher (P= .08) at hospital admission using HADS. Exposure to contact precautions was not associated with increased depression (P= .42) or anxiety (P= .25) on hospital day 3. On hospital day 3, patients under contact precautions were no more likely than unexposed patients to be angry (20% vs 20%;P= .99), sad (33% vs 38%;P= .45), worried (51% vs 46%;P= .41), happy (58% vs 67%;P= .14), or confused (23% vs 24%;P= .95).Conclusions.Patients under contact precautions have more symptoms of depression and anxiety at hospital admission but do not appear to be more likely to develop depression, anxiety, or negative moods while under contact precautions. The use of contact precautions should not be restricted by the belief that contact precautions will produce more depression or anxiety.

scholarly journals The Effect of Contact Precautions on Frequency of Hospital Adverse Events

2015 ◽  
Vol 36 (11) ◽  
pp. 1268-1274 ◽  
Author(s):  
Lindsay D. Croft ◽  
Michael Liquori ◽  
James Ladd ◽  
Hannah Day ◽  
Lisa Pineles ◽  
...  
Keyword(s):  
Adverse Events ◽  
Hospital Stay ◽  
Medical Center ◽  
Tertiary Care ◽  
Hospital Ward ◽  
Day Length ◽  
Care Hospital ◽  
University Of Maryland ◽  
Contact Precautions ◽  
Hospital Wards

OBJECTIVETo determine whether use of contact precautions on hospital ward patients is associated with patient adverse eventsDESIGNIndividually matched prospective cohort studySETTINGThe University of Maryland Medical Center, a tertiary care hospital in Baltimore, MarylandMETHODSA total of 296 medical or surgical inpatients admitted to non–intensive care unit hospital wards were enrolled at admission from January to November 2010. Patients on contact precautions were individually matched by hospital unit after an initial 3-day length of stay to patients not on contact precautions. Adverse events were detected by physician chart review and categorized as noninfectious, preventable and severe noninfectious, and infectious adverse events during the patient’s stay using the standardized Institute for Healthcare Improvement’s Global Trigger Tool.RESULTSThe cohort of 148 patients on contact precautions at admission was matched with a cohort of 148 patients not on contact precautions. Of the total 296 subjects, 104 (35.1%) experienced at least 1 adverse event during their hospital stay. Contact precautions were associated with fewer noninfectious adverse events (rate ratio [RtR], 0.70; 95% confidence interval [CI], 0.51–0.95; P=.02) and although not statistically significant, with fewer severe adverse events (RtR, 0.69; 95% CI, 0.46–1.03; P=.07). Preventable adverse events did not significantly differ between patients on contact precautions and patients not on contact precautions (RtR, 0.85; 95% CI, 0.59–1.24; P=.41).CONCLUSIONSHospital ward patients on contact precautions were less likely to experience noninfectious adverse events during their hospital stay than patients not on contact precautions.Infect. Control Hosp. Epidemiol. 2015;36(11):1268–1274

NosocomialSerratia marcescensInfections Associated With Extrinsic Contamination of a Liquid Nonmedicated Soap

2000 ◽  
Vol 21 (3) ◽  
pp. 196-199 ◽  
Author(s):  
Catherine Sartor ◽  
Véronique Jacomo ◽  
Cédric Duvivier ◽  
Hervé Tissot-Dupont ◽  
Roland Sambuc ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Tertiary Care ◽  
Hand Washing ◽  
Environmental Investigation ◽  
Hospital Units ◽  
Before And After ◽  
Tertiary Care Hospitals ◽  
The Relationship ◽  
Control Study

AbstractObjective:To determine the role of nonmedicated soap as a source ofSerratia marcescensnosocomial infections (NIs) in hospital units with endemicS marcescensNI and to examine the mechanisms of soap colonization.Setting:University-affiliated tertiary-care hospitals.Methods:A prospective case-control study and an environmental investigation were performed to assess the relationship betweenS marcescensNIs in hospital units andS marcescens-contaminated soap. Soap-bottle use and handwashing practices were reviewed. Cultures of healthcare workers’ (HCWs) hands were obtained before and after hand washing with soap.Results:5 of 7 hospital units withS marcescensNIs had soap bottles contaminated withS marcescens, compared to 1 of 14 other units (P=.006). After hand washing with anS marcescens-contaminated soap pump, HCWs' hands were 54 times more likely to be contaminated withS marcescens(P<.001).Conclusions:Extrinsic contamination of a non-medicated liquid soap byS marcescensresulted in handborne transmission ofS marcescensNIs by HCWs in our setting. This finding led to the application of strict guidelines for nonmedicated soap use and to the reinforcement of alcoholic hand disinfection.

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