Isolation Precautions for Methicillin-Resistant Staphylococcus aureus: Electronic Surveillance to Monitor Adherence

Abstract

The Centers for Disease Control and Prevention recently updated guidelines for isolation precautions and added specific recommendations for the management of multidrug-resistant organisms. However, the extent to which these recommendations are followed is unknown. Although the recommendations are based on studies with high internal validity, the effectiveness of these interventions in clinical practice also is unknown. Evidence of the effectiveness of isolation precautions for preventing transmission of infections caused by multidrug-resistant organisms in acute care settings, with methicillin-resistant Staphylococcus aureus as an example, was reviewed. Despite a lack of experimental data, numerous descriptive and correlational studies and a sound theoretical rationale strongly suggest that barrier precautions play an important role in the prevention of transmission of infections due to multidrugresistant organisms. Two major problems, however, still exist. First, staff members' adherence to national recommendations on isolation precautions, although insufficiently described, appears to be inadequate. Second, efficient, reproducible methods for ongoing surveillance of practices such as isolation precautions are not readily available. Automated surveillance systems that provide support for making decisions are promising for this purpose, are likely to result in cost savings, and therefore warrant more widespread development, testing, and implementation.

Risk factors and outcomes of infections caused by extremely drug-resistant gram-negative bacilli in patients hospitalized in intensive care units

“…Potential subjects were identified prospectively using EpiPortal, a web-based surveillance system developed by the NYP Department of Infection Prevention & Control and Department of Information Technology and Columbia University Department of Biomedical Informatics [9]. EpiPortal integrates data from different electronic systems (e.g., microbiology laboratories, pharmacy, medical records) to identify patients with epidemiologically significant organisms including multidrug-resistant pathogens.…”

Putting Evidence Into Nursing Practice: Four Traditional Practices Not Supported by the Evidence

“…54,57 The concept of infection control is more frequently referred to today as infection prevention, but the 2 concepts work in tandem: specific interventions must be implemented consistently by health care workers to prevent HCAI in patients, and when infections are present, health care workers must take action to control the spread of the infection. [52][53][54][55][56] Prevention and control of infections in health care settings is an "old" idea and has been evident in the literature for more than 50 years.…”

Monitoring Universal Protocol Compliance Through Real-Time Clandestine Observation by Medical Students Results in Performance Improvement

“…Direct observation of components of universal protocol compliance has been reported, [10][11][12] but it can be labor and resource intensive and may be subject to bias because of oversampling selected shifts. 7 At Tufts Medical Center, a WSS occurred in 2008. Operating room administration was challenged to develop a better method to monitor compliance, supply feedback to surgical teams, and to measure their impact on our safety related policies and procedures over time.…”

“…5 Instead, hospital administrators often measure safety and quality protocol compliance through peer audits, selfreport questionnaires, or chart audits. [6][7][8][9] Questionnaires and chart audits supply information conveniently, but these strategies alone may not be fully representative of universal protocol compliance and may not capture select components of the Joint Commission guidelines. For example, individual features of a hospital's universal protocol process may not be detailed in the chart, including correct incision site marking, display of appropriate radiographic images, discussion of pertinent patient care issues before incision, or "white board" filled out to completion.…”