title: Back to basics: Four years of sustained improvement in implementation of contact precautions at a university hospital.
abstract: BACKGROUND
  The use of contact precautions is an essential component of an effective multidrug-resistant organism (MDRO) control plan. Despite reliance on a passive automated reminder system to alert clinicians of the need for contact precautions, poor adherence was recognized at the study medical center. DEVELOPING THE INTERVENTION: A performance improvement project incorporating brief weekly surveillance rounds on each inpatient unit was developed to maximize compliance with implementation of contact precautions and to evaluate risk factors for failure to institute precautions. In the weekly rounds, infection preventionists determined the point prevalence of the appropriate implementation of contact precautions for MDRO (that is, whether or not patients with electronic flags had been appropriately placed on contact precautions). This project was evaluated during a 22-week rollout period followed by a four-year follow-up period. The experience and data derived from the rollout period were intended to shape the long-term plan to sustain high levels of compliance with contact-precaution initiation.
  
  
  RESULTS
  During the first week of surveillance, only 70% of eligible patients were isolated, but by week 16 90% were isolated appropriately. Because surveillance rounding was successful in improving institution of contact precautions during the rollout period, this practice was continued. During the following four years (follow-up period), > or = 90% success at implementing isolation precautions was demonstrated during 74% of the weeks.
  
  
  CONCLUSIONS
  This experience with surveillance demonstrated an effective, practical, and sustainable method of improving implementation of contact precautions for patients with MDRO.
authors.affiliation: Section of Infectious Diseases and Global Health, University of Chicago Medical Center, Chicago, USA. emily.mawdlsey@uchospitals.edu
authors.forename: Emily Landon
authors.initials: EL
authors.lastname: Mawdsley
authors.forename: Sylvia
authors.initials: S
authors.lastname: Garcia-Houchins
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Weber
mesh_terms: D003428:Cross Infection / Q000517:prevention & control*; D024901:Drug Resistance, Multiple, Bacterial; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000592:standards; D010356:Patient Isolation / Q000592:standards / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care