Clostridium difficile infections (CDI) pose a major threat to patient safety. Enhanced contact precautions including soap and water hand washing and gowns and gloves worn by healthcare workers for encounters involving known or suspected CDI are employed to prevent healthcare-associated transmission. Our objective was to characterize enhanced contact precaution compliance in an emergency department (ED) setting.
A research assistant identified patients placed into enhanced contact precautions and directly observed provider interactions. Adherence to each element of enhanced contact precautions was recorded. For each patient, no more than two encounters were recorded per provider. To minimize any observer effect, providers were blinded to the data being collected. To avoid influencing hand hygiene behavior, the observer always followed the provider into the room, and then waited for the provider to depart before washing his own hands. Differences between groups were analyzed using Fisher’s exact test.
Observations were conducted during 50 patient encounters (16 attending physicians, 13 resident physicians, 14 RNs, 5 techs, 2 pharmacists). Complete enhanced contact precaution compliance was observed in only 8/50 (16%) encounters. Physicians were compliant with gown and glove precautions during encounters with patients on enhanced contact precautions 66% of the time compared to non-physicians who were 67% compliant (Difference 1%, 95% CI -24 to 26; p=1.0). Physicians were compliant with hand hygiene using soap and water following encounters with patients in enhanced contact precautions 38% of the time compared to non-physician providers who were 19% compliant (Difference 19%, 95% CI -6 to 44; p=.21).
Failure to perform hand hygiene with soap and water following the encounter was a frequent cause of enhanced contact precaution non-compliance. Physicians demonstrated a higher, yet non-statistically significant, rate of compliance with soap and water hand hygiene. Understanding provider workflows in the busy environment of an ED setting is essential to optimizing compliance with enhanced contact precautions, particularly hand hygiene with soap and water for all types of healthcare workers in the ED.
B. Sharp, None
S. Zidovetzki, None
A. Hamedani, None
N. Safdar, None
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