Outcomes from a modified contact precautions strategy for an Intensive Care Unit (ICU)

Katherine Shepherd 

Research/Data Coordinator, Monash Health, 135 David St Dandenong, VIC, Australia

 

Introduction
ICU patients are at higher risk of becoming colonised or infected with antibiotic resistant micro-organisms such as Methicillin Resistant Staphylococcus (MRSA) and Vancomycin Resistant Enterococcus (VRE). Transmission-based contact precautions and correct hand hygiene practices are designed to minimise the transmission of such micro-organisms.
Through direct observation and routine auditing in a metropolitan Level II ICU it was observed that compliance to both Transmission-based contact precautions and correct hand hygiene associated with glove use, was poor. This has led to a Quality project aimed at improving this compliance and minimising the transmission of antibiotic resistant micro-organisms.

Method
For a period of 6 months the routine use of long sleeve impervious gowns and gloves on entering the room or bedspace of a patient isolated in Transmission based Contact Precautions for MRSA and VRE was replaced with disposable plastic aprons and gloves for direct patient contact only. Changes were also made to when staff could enter a room or bedspace without PPE. All patients admitted to the ICU colonised or infected with MRSA or VRE during the trial period were cared for with these modified contact precautions.

Results
Results included an overall trend downward in transmissions when adjusted for bed days, increased compliance with both hand hygiene associated with glove use and contact precautions. Increased staff satisfaction and patient outcomes, a decrease in the production of waste and cost savings. This has led to a sustained practice change which has been supported by both the Infection Control and Infectious Diseases Departments.

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