Monday, December 17, 2012

Contact precautions: who wins, who loses?

The January issue of ICHE has some new data on the effects of contact precautions (CP) from Daniel Morgan and colleagues (full disclosure: “colleagues” here includes fellow blogger Eli, the senior author on this paper). We’ve had a lot to say on controversies around CP, and there has been increased attention to the potential for unintended adverse consequences over the past decade. It was about 10 years ago that three separate studies reported that CP resulted in reductions in both healthcare worker (HCW)-patient visits and in HCW-patient contact time. An optimist might predict that the increased focus on this issue would lead to some lessening of the impact of CP as HCWs became more aware of these effects.

The optimist would be wrong. In this study done in 2010 and 2011—prospective and multi-center, using trained research staff to observe almost eight thousand healthcare worker visits over almost 2000 total observation hours—Morgan et. al. found almost exactly the same effect. Patients in CP had 36% fewer HCW visits, and 18% less direct contact time with HCWs. Notably, the difference was seen on non-ICU wards, not in the ICU.

This study also confirms a prior finding regarding hand hygiene (HH) and CP: that HCWs are more likely to perform HH after visiting a patient in CP than someone not under CP (63% vs. 47%, respectively). As for CP generally, this effect is likely to benefit the next patient seen by the HCW (not the patient being cared for under CP). As we’ve pointed out before, one of the ethical problems with CP is that the potential risks and benefits are not distributed fairly; patients placed in contact precautions are exposed to the risks, while those not isolated experience the benefit.

Photo from Cardinal Health

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