title: Is evidence guiding practice? Reported versus observed adherence to contact precautions: a pilot study.
abstract: BACKGROUND
  Hospital-acquired infections are a major patient safety issue. We examined staff members' knowledge, attitudes, reported and observed adherence to guidelines, and perceptions of barriers to use of contact precautions.
  
  
  METHODS
  A survey and nonparticipant observation study was used to examine knowledge, attitudes, perceptions, and actual behavior of staff on 3 medical/surgical units at a 600-bed Magnet-designated academic medical center (MDAMC) and a 110-bed community medical center (CMC) in the southeastern United States.
  
  
  RESULTS
  Correct knowledge answers ranged from 75% (CMC) to 100% (MDAMC). CMC participants were less likely to perceive time as a barrier (5% vs 25%; P = .050); more MDAMC participants were motivated by supervisors' recognition (87% vs 33%; P = .001). No statistically significant differences existed between groups on reported behaviors. Upon observation, fewer CMC participants demonstrated 4 of 5 evidence-based contact precaution behaviors compared with MDMC participants (P < .001). Hand hygiene before glove application was similarly low at both sites.
  
  
  CONCLUSIONS
  Despite a decade of focus on improving patient safety, low adherence to evidence-based practice guidelines for implementation of contact precautions remains. Ongoing efforts are needed both at the system and practitioner level to improve practice adherence.
authors.affiliation: Vanderbilt University School of Nursing, Vanderbilt University, Nashville, TN. Electronic address: Mary.a.jessee@vanderbilt.edu.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Jessee
authors.forename: Lorraine C
authors.initials: LC
authors.lastname: Mion
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D006282:Health Personnel; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011361:Professional Competence; D015144:Southeastern United States
keywords: Adherence; Attitudes; Health care-associated infections; Infection control; Practices