Clean hands, don gloves, gown and mask. Treat the patient. Discard gloves, gown and mask using correct process and sequence to avoid hand and clothing contamination. Exit room. The same patient rings the call bell. EXHALE. Re-enter the room. Repeat the procedure.
Anyone experienced with contact precautions (isolation) understands the importance of preventing transmission. Unfortunately, isolation not only takes its toll on patients but on hospital staff as well.
Impact of Isolation on Nurses
Most studies published on the topic of transmission-based precautions, or isolation, focus on the perspective of the patient. These generally report an increased risk of adverse events, and reduced patient satisfaction as reflected in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.
The few studies addressing the impact of isolation on nurses, report different, though similarly negative effects. In one recent study, the majority of nurses interviewed reported dissatisfaction with isolation due to the additional amount of work required in donning and doffing gloves and gowns.1 This has been reported in others studies, and has been characterized as a limiting factor in caring for these patients.2
Another researcher reported that half of healthcare providers (both MDs and nurses) queried were concerned that patient care provided to patients on contact precautions
was different, and that these patients had a higher risk and rate of adverse events. They also reported dissatisfaction with the amount of time these patients required compared to other patients. And interestingly, both MDs and nurses reported being concerned regarding contracting an infection from patients on isolation.3
Perhaps this comes as no surprise.
Trend to reduce Contact Precautions
In recent years there has been a reported trend towards eliminating the need for contact isolation for patients colonized versus infected with MRSA, without increasing transmission risk. In all reports, this has resulted in increased satisfaction on both the part of the nurses and the patients. Often, to ensure there is no increased transmission risk, decolonization of these patients is performed in the place of contact precautions. Decolonization protocols typically involve both skin (with chlorhexidine) and nose of the patient.
There are now nasal antiseptic options for nasal decolonization (alcohol and iodine) with equivalent or better efficacy compared to mupirocin (antibiotic), and which support antibiotic stewardship programs.4,5
So in fact there is a reason to be hopeful about reducing the incidence of Contact Precautions.
- Ngam C1, Schoofs Hundt A2, Haun N3, Carayon P4, Stevens L5, Safdar N6. Barriers and facilitators to Clostridium difficile infection prevention: A nursing perspective. Am J Infect Control.2017 Dec 1;45(12):1363-1368.
- Knowles, H. E. (1993). The experience of infectious patients in isolation. Nursing Times, 89(30), 53-56.
- Khan, F., Khakoo, R., & Hobbs, G. (2006). Impact of contact isolation on health care workers at a tertiary care center. American Journal of Infection Control, 34(7), 408-413.
- Septimus EJ1, Schweizer ML2. Decolonization in Prevention of Health Care-Associated Infections. Clin Microbiol Rev.2016 Apr;29(2):201-22.
- Deatherage N. Impact of reduced isolation and contact precaution procedures on infection rates and facility costs at a nonprofit acute care hospital. American Journal of Infection Control 2016 44:6 (S101-S102).