Background: In December 2014, Cambridge Health Alliance (CHA) discontinued contact precautions (CPs) for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) based on lack of evidence showing that CPs decrease the rate of transmission of these organisms in endemic settings. There is evidence that patient isolation may cause harm. We surveyed staffs beliefs, comfort, knowledge, and practices surrounding hand hygiene, standard precautions (SPs), and CPs. The goal was to shed light on knowledge gaps, misconceptions, or practice inconsistencies.
Methods: A ten-minute, 38-question English anonymous online survey was designed, piloted in three successive iterations, and deployed in February 2017 to staff who perform clinical work in two inpatient and three emergency departments at a safety-net organization. Four email reminders were sent. 100 respondents were randomly selected to receive a $10 cafeteria gift card. Data were obtained and analyzed via Google tools.
Results: Among 1804 providers, 202 (11%) completed the survey. 90% of respondents recognize unclean hands are the main route of cross-transmission. Most (54%) incorrectly believe VRE requires CPs, and over a third (38%) for MRSA. Half are comfortable caring for MRSA/ VRE patients without CPs. While 29% reported previously spending less time with isolated MRSA/ VRE patients than non-isolated patients, significantly fewer are spending less time with these patients since the change (13%, p<0.001; see graph). 43% agree that their job efficiency has improved.
Conclusion: Staff understand the importance of hand hygiene in preventing cross-transmission. Misconceptions over CP and SP persist, indicating a need for further education. The majority of respondents are pleased with the change. Staff are spending more time with patients who were previously isolated. There are varying beliefs across professional roles, which are also reflected in the Beth Israel Deaconess Medical Centers (BIDMC) survey conducted within a year of their intervention. More CHA trainees agree that CP prevent cross-transmission than BIDMC trainees, although two-thirds of them were not at CHA during the change implementation, suggesting the need for reinforcing rationale for new hires.
L. A. Bruno-Murtha, None