The Impact of Isolation on Healthcare Worker Contact and Compliance With Infection Control Practices in Nursing Homes

Abstract

OBJECTIVETo directly observe healthcare workers in a nursing home setting to measure frequency and duration of resident contact and infection prevention behavior as a factor of isolation practiceDESIGNObservational studySETTING AND PARTICIPANTSHealthcare workers in 8 VA nursing homes in Florida, Maryland, Massachusetts, Michigan, Washington, and TexasMETHODSOver a 15-month period, trained research staff without clinical responsibilities on the units observed nursing home resident room activity for 15-30-minute intervals. Observers recorded time of entry and exit, isolation status, visitor type (staff, visitor, etc), hand hygiene, use of gloves and gowns, and activities performed in the room when visible.RESULTSA total of 999 hours of observation were conducted across 8 VA nursing homes during which 4,325 visits were observed. Residents in isolation received an average of 4.73 visits per hour of observation compared with 4.21 for nonisolation residents (P<.01), a 12.4% increase in visits for residents in isolation. Residents in isolation received an average of 3.53 resident care activities per hour of observation, compared with 2.46 for residents not in isolation (P<.01). For residents in isolation, compliance was 34% for gowns and 58% for gloves. Healthcare worker hand hygiene compliance was 45% versus 44% (P=.79) on entry and 66% versus 55% (P<.01) on exit for isolation and nonisolation rooms, respectively.CONCLUSIONSHealthcare workers visited residents in isolation more frequently, likely because they required greater assistance. Compliance with gowns and gloves for isolation was limited in the nursing home setting. Adherence to hand hygiene also was less than optimal, regardless of isolation status of residents.Infect Control Hosp Epidemiol 2018;39:683-687.

The devil is in the details: Factors influencing hand hygiene adherence and contamination with antibiotic-resistant organisms among healthcare providers in nursing facilities

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“…Although barrier precautions were required for direct care within the room, compliance was low, with 58% of HCP using gloves and 34% using gowns. 7 The frequency of contact with the patient or environment within the room was not monitored, so numbers between these 2 studies are not directly comparable. Therefore, we could not estimate the total amount of contact between residents and staff inside of rooms versus outside the rooms, but direct contact with staff was considerable in common areas, especially in rehabilitation.…”

De-escalation of asymptomatic testing and potential of future COVID-19 outbreaks in US nursing homes amidst rising community vaccination coverage: A modeling study

“…Facility-level PPE adherence. Adherence to PPE use by healthcare staff in nursing homes has been less than optimal before the COVID-19 pandemic [36] . In the beginning of the pandemic, initial CMS surveys (during the week of March 30, 2020) found that 25% of inspected facilities failed to demonstrate proper use of PPE [37] .…”