Surveillance Can Help Boost Implementation of Contact Precautions

The use of contact precautions is an essential component of an effective control plan for multidrug-resistant organisms (MDROs). Emily Mawdsley, of the section of Infectious Diseases and Global Health at the University of Chicago Medical Center, and colleagues, report that despite a passive automated reminder system to alert clinicians of the need for contact precautions, poor adherence was recognized at the medical center.

Mawdsley, et al. (2010) developed a performance improvement project incorporating brief weekly surveillance rounds on each inpatient unit to maximize compliance with implementation of contact precautions and to evaluate risk factors for failure to institute precautions. In the weekly rounds, infection preventionists determined the point prevalence of the appropriate implementation of contact precautions for MDROs (whether or not patients with electronic flags had been appropriately placed on contact precautions). This project was evaluated during a 22-week rollout period followed by a four-year follow-up period. The experience and data derived from the roll-out period were intended to shape the long-term plan to sustain high levels of compliance with contact-precaution initiation.

The researchers report that during the first week of surveillance, 70 percent of eligible patients were isolated, but by week 16, 90 percent of eligible patients were isolated appropriately. Because surveillance rounding was successful in improving institution of contact precautions during the rollout period, this practice was continued. During the following four years (follow-up period), > or = 90 percent success at implementing isolation precautions was demonstrated during 74 percent of the weeks. The researchers say that this experience with surveillance demonstrated an effective, practical and sustainable method of improving implementation of contact precautions for patients with MDROs.

Reference: Mawdsley EL, Garcia-Houchins S, Weber SG. Back to basics: Four years of sustained improvement in implementation of contact precautions at a university hospital. Jt Comm J Qual Patient Saf. 2010 Sep;36(9):418-23.