title: The effect of contact precautions on healthcare worker activity in acute care hospitals.
abstract: OBJECTIVE
  Contact precautions are a cornerstone of infection prevention but have also been associated with less healthcare worker (HCW) contact and adverse events. We studied how contact precautions modified HCW behavior in 4 acute care facilities.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Four acute care facilities in the United States performing active surveillance for methicillin-resistant Staphylococcus aureus.
  
  
  METHODS
  Trained observers performed "secret shopper" monitoring of HCW activities during routine care, using a standardized collection tool and fixed 1-hour observation periods.
  
  
  RESULTS
  A total of 7,743 HCW visits were observed over 1,989 hours. Patients on contact precautions had 36.4% fewer hourly HCW visits than patients not on contact precautions (2.78 vs 4.37 visits per hour; [Formula: see text]) as well as 17.7% less direct patient contact time with HCWs (13.98 vs 16.98 minutes per hour; [Formula: see text]). Patients on contact precautions tended to have fewer visitors (23.6% fewer; [Formula: see text]). HCWs were more likely to perform hand hygiene on exiting the room of a patient on contact precautions (63.2% vs 47.4% in rooms of patients not on contact precautions; [Formula: see text]).
  
  
  CONCLUSIONS
  Contact precautions were found to be associated with activities likely to reduce transmission of resistant pathogens, such as fewer visits and better hand hygiene at exit, while exposing patients on contact precautions to less HCW contact, less visitor contact, and potentially other unintended outcomes.
authors.affiliation: University of Maryland School of Medicine, Baltimore, Maryland, USA. dmorgan@epi.umaryland.edu
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Morgan
authors.forename: Lisa
authors.initials: L
authors.lastname: Pineles
authors.forename: Michelle
authors.initials: M
authors.lastname: Shardell
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Graham
authors.forename: Shahrzad
authors.initials: S
authors.lastname: Mohammadi
authors.forename: Graeme N
authors.initials: GN
authors.lastname: Forrest
authors.forename: Heather S
authors.initials: HS
authors.lastname: Reisinger
authors.forename: Marin L
authors.initials: ML
authors.lastname: Schweizer
authors.forename: Eli N
authors.initials: EN
authors.lastname: Perencevich
mesh_terms: D003428:Cross Infection / Q000517:prevention & control* / Q000523:psychology; D019983:Guideline Adherence; D006235:Hand Disinfection; D006787:Hospitals, Veterans; D006801:Humans; D007362:Intensive Care Units; D010356:Patient Isolation / Q000523:psychology; D061214:Patient Safety; D011369:Professional-Patient Relations; D011446:Prospective Studies; D011481:Protective Clothing; D014481:United States; D014789:Visitors to Patients