title: Contact precautions: more is not necessarily better.
abstract: OBJECTIVE
  To determine whether increases in contact isolation precautions are associated with decreased adherence to isolation practices among healthcare workers (HCWs).
  
  
  METHODS
  Prospective cohort study from February 2009 to October 2009.
  
  
  METHODS
  Eleven teaching hospitals.
  
  
  METHODS
  HCWs.
  
  
  METHODS
  One thousand thirteen observations conducted on HCWs. Additional data included the number of persons in isolation, types of HCWs, and hospital-specific contact precaution practices. Main outcome measures included compliance with individual components of contact isolation precautions (hand hygiene before and after patient encounter, donning of gown and glove upon entering a patient room, and doffing upon exiting) and overall compliance (all 5 measures together) during varying burdens of isolation.
  
  
  RESULTS
  Compliance with hand hygiene was as follows: prior to donning gowns/gloves, 37.2%; gowning, 74.3%; gloving, 80.1%; doffing of gowns/gloves, 80.1%; after gown/glove removal, 61%. Compliance with all components was 28.9%. As the burden of isolation increased (20% or less to greater than 60%), a decrease in compliance with hand hygiene (43.6%-4.9%) and with all 5 components (31.5%-6.5%) was observed. In multivariable analysis, there was an increase in noncompliance with all 5 components of the contact isolation precautions bundle (odds ratio [OR], 6.6 [95% confidence interval (CI), 1.15-37.44]; P = .03) and in noncompliance with hand hygiene prior to donning gowns and gloves (OR, 10.1 [95% CI, 1.84-55.54]; P = .008) associated with increasing burden of isolation.
  
  
  CONCLUSIONS
  As the proportion of patients in contact isolation increases, compliance with contact isolation precautions decreases. Placing 40% of patients under contact precautions represents a tipping point for noncompliance with contact isolation precautions measures.
authors: Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors: Sorabh
authors: S
authors: Dhar
authors: Dror
authors: D
authors: Marchaim
authors: Ryan
authors: R
authors: Tansek
authors: Teena
authors: T
authors: Chopra
authors: Adnan
authors: A
authors: Yousuf
authors: Ashish
authors: A
authors: Bhargava
authors: Emily T
authors: ET
authors: Martin
authors: Thomas R
authors: TR
authors: Talbot
authors: Laura E
authors: LE
authors: Johnson
authors: Ameet
authors: A
authors: Hingwe
authors: Jerry M
authors: JM
authors: Zuckerman
authors: Bartholomew R
authors: BR
authors: Bono
authors: Emily K
authors: EK
authors: Shuman
authors: Jose
authors: J
authors: Poblete
authors: MaryAnn
authors: M
authors: Tran
authors: Grace
authors: G
authors: Kulhanek
authors: Rama
authors: R
authors: Thyagarajan
authors: Vijayalakshmi
authors: V
authors: Nagappan
authors: Carrie
authors: C
authors: Herzke
authors: Trish M
authors: TM
authors: Perl
authors: Keith S
authors: KS
authors: Kaye
mesh_terms: D003428:Cross Infection / Q000517:prevention & control*; D017575:Gloves, Protective / Q000706:statistics & numerical data; D019983:Guideline Adherence; D063373:Hand Hygiene / Q000706:statistics & numerical data; D006784:Hospitals, Teaching; D006801:Humans; D010356:Patient Isolation; D010564:Personnel, Hospital / Q000706:statistics & numerical data; D011446:Prospective Studies; D011481:Protective Clothing / Q000706:statistics & numerical data