462. “All Eyes on You”: A Covert Observational Study on Contact Precaution Compliance in Six Hospitals at the Detroit Medical Center.
Session: Poster Abstract Session: Healthcare Epidemiology: Advances in Hand Hygiene
Thursday, October 4, 2018
Room: S Poster Hall
Background: The Center for disease control and prevention recommends strict contact isolation precautions (CP) that include hand hygiene(HH) and barrier (gloves and gown) precautions upon entering and leaving the rooms of patients diagnosed with multidrug resistant organism or clostridium difficile infections. Although this policy has been in place for several years, compliance rate among HCW are rarely studied. The aim of our study was to covertly monitor, analyze and compare the overall bundle compliance (OBC) and individual (HH, glove and gown) component compliance (ICC) among HCWs during routine patient care.

Methods: A prospective observational study was done in six Detroit Medical Centers (July 2017 to February 2018). Trained observers audited both inpatient and intensive care units on random days and time. Components audited (1) HH before donning and after doffing (2) gowning and gloving techniques before entering and after existing the pt room. A mobile application (speedy audit) was used to record all data. A pilot targeted education program (TEP) was also conducted in one of the hospital where education was focused only on strict HH practice before donning.

Results: A total of 6274 observations were collected. The OBC was 38%. Common HCWs observed included Nurses (registered nurse and nursing student)- 47%; Physicians (attending’s, residents, fellows) - 28%; Service workers including Environmental Service, Food service, Patient transporter, Social worker, Pastoral care- 14%; Allied Health Professions including Dietician, Blood Collection, Physiotherapist, Radiology Tech, Respiratory Therapist-4%; The OBC among all HCW were below 50%.

For the ICC, HH (49%) was way below the gloving (80%,) and gowning (62%)compliance. HH compliance before donning was strikingly lower (40%) than the compliance after doffing (62%). This trend was similar in all HCW. Within a month of TEP, a drastic increase in both HH [↑to 75% from 26% (P < 0.001)] and OBC [↑to 68% from 16% (P < 0.001)] was seen.

Conclusion: Common misconception that gloves are substitute to HH could explain the low HH rates before donning. Recognition of this gap and focused education on HH before donning has led to improved compliance in all HCW.

Suganya Chandramohan, MD1, Amar Krishna, MD1, Bhagyashri Navalkele, MD1, Parminder Virdi, MD1, Angad Gill, MD2, Ibtehaj Javed, MD1, Anupamdeep Mehar, MD1, Nikhila Thammineni, MD1, Takwi Muma, MD1, Aleena Saleem, MD1, Syed Ali Mehdi Kazmi, MD1, Ummah Salma, MD1, Manbeer Sarao, MD1, Christina Reji, MD1, Fareeza Afzal, BS1, Aditi Sharma, MD1, Manpreet Arora, MD1, Robin J Sharma, MD2, Iyad Farouji, MD1, Hala Dubaybo, MS1, Dania Qaryoute, MD1, David Skye, MS1, Gayathri Mudali, MD1, Daniel Deporre, MD1, Allison McMillan, BS1, Muhammad Ebad Ur Rehman, MD1, Aleena Mirza, BS1, Rasika Patil, MS1, Yusuf Khalil, BS1, Ahmed Ghufran, MD1, Eshani Malhotra, BS1, Serena Latief, BS1, Jennifer LeRose, MPH3, Judy Moshos, MT (ASCP), CIC4,5, Lynn Semproch, MPH, CIC6, Samyah Mogalli, MHSA, MT(ASCP)7, Thomas Chevalier, RN, BSN, CIC8, Nancy Baran, MS, CIC8, Margaret Turner, M.Ed., CIC, RN7, Syed Hussain, MD9, Teena Chopra, MD, MPH1 and Division of Infection Control and Hospital Epidemiology , (1)Division of Infection Control and Hospital Epidemiology, Detroit Medical Center, Detroit, MI, (2)Division of Infection Control and Hospital Epidemiology, Detroit Medical Center/, Detroit, MI, (3)Quality and Safety, Detroit Medical Center, Detroit, MI, (4)Detroit Medical Center / Wayne State University, Detroit, MI, (5)Detroit Medical Center/Wayne State University, Detroit, MI, (6)Epidemiologist, Children's Hospital of Michigan/Detroit Medical Center, Detroit, MI, (7)Detroit Medical Center, Detroit, MI, (8)Infection Prevention and Hospital Epidemiology, Detroit Medical Center, Detroit, MI, (9)Department of Internal Medicine, Detroit Medical Center SGH/HVSH, Detroit, MI

Disclosures:

S. Chandramohan, None

A. Krishna, None

B. Navalkele, None

P. Virdi, None

A. Gill, None

I. Javed, None

A. Mehar, None

N. Thammineni, None

T. Muma, None

A. Saleem, None

S. A. Mehdi Kazmi, None

U. Salma, None

M. Sarao, None

C. Reji, None

F. Afzal, None

A. Sharma, None

M. Arora, None

R. J. Sharma, None

I. Farouji, None

H. Dubaybo, None

D. Qaryoute, None

D. Skye, None

G. Mudali, None

D. Deporre, None

A. McMillan, None

M. E. Ur Rehman, None

A. Mirza, None

R. Patil, None

Y. Khalil, None

A. Ghufran, None

E. Malhotra, None

S. Latief, None

J. LeRose, None

J. Moshos, None

L. Semproch, None

S. Mogalli, None

T. Chevalier, None

N. Baran, None

M. Turner, None

S. Hussain, None

T. Chopra, None

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