Implementation of isolation precautions: role of a targeted information flyer
Introduction
Isolation precautions are advocated in most countries to curb the spread of multi-drug-resistant organisms.1, 2 At Pitie-Salpetriere Hospital, a 2000-bed university hospital located in Paris, France, a methicillin-resistant Staphylococcus aureus (MRSA) control programme was established in 1992. It included isolation precautions and systematic flagging of every MRSA-positive bacteriological result with a coloured stamp. Additional measures were implemented for intensive care units (ICUs) and the rehabilitation unit, including a phone call from the infection control (IC) physician to the physician in charge of each newly recognized MRSA patient, a ward visit by IC staff (mainly IC nurses) on the same day of MRSA isolation whenever possible, and active screening on admission. For other wards, visits by IC staff were made on demand, and phone calls were made by bacteriologists only in cases of severe infection. This strategy resulted in a decrease in the number of clinical isolates of MRSA as a proportion of all clinical isolates of S. aureus from 39% in 1992 to 24% in 2002, and a decrease in MRSA incidence for 1000 patient days from 1.33 to 0.75.
Further to decrease MRSA incidence in 2003, and because observational studies indicated that isolation precautions were poorly implemented outside the ICUs, the IC team decided to extend ‘MRSA rounds’ to all wards. However, this expansion could not be implemented because of high workload. Therefore, we conducted a study comparing implementation of isolation precautions before and after distribution of a new targeted reminder, limiting interventions of IC nurses to high-risk wards without neglecting low-risk wards.
Section snippets
Methods
Two three-month periods were compared. During the first three months (control period), the hospital strategy remained the same as described above. Implementation of isolation precautions was checked for all new MRSA carriers during unannounced visits. Thereafter, a new information sheet named ‘isolation precautions at a glance’, providing a quick reference to steps to be implemented for MRSA carriers and printed on brightly coloured paper, was stapled to every MRSA-positive result by
Results
A total of 89 MRSA patients were observed during the control period, and 76 during the intervention period. The median time between the date when the first MRSA-positive sample was collected and observation of isolation precautions was four days for both periods (P=0.05). The medical and nursing staff reported that they knew the MRSA status of patients in 87% of cases in the control period, and in 96% of cases in the intervention period (P=0.03). Medical and nursing records were flagged
Discussion
By providing a standard ready-to-use guide for precautions to be implemented, we significantly improved isolation precautions for MRSA in our institution. To our knowledge, this is the first report to describe the use of a targeted information flyer for improvement of isolation precautions.
As shown by others3 and suggested by our data comparing isolation precautions in wards with and without IC nurse rounds, ward rounds assist in the implementation of isolation precautions and provide timely
Acknowledgements
The authors wish to thank all of the bacteriologists of the hospital for sending out the new information flyer.
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Preventing healthcare-associated infections: Residents and attending physicians need better training in advanced isolation precautions
2016, Medecine et Maladies InfectieusesCitation Excerpt :Physicians were also informed in case of MDRB by a sticker added to the bacteriological result advising them to seek advice from the Infection Control Unit to implement hygiene measures. Such practice was associated with an increased compliance with IP prescription guidelines [17]. Standard precautions remain the cornerstone of the prevention against crossed-transmission and must be applied regardless of the patient's infectious status [18,19].
Information concerning multidrug-resistant bacterial colonization or infection in the medical transfer letter
2015, Medecine et Maladies InfectieusesCitation Excerpt :This could be due to the additional message, sent with microbiological results, indicating the presence of specific resistance to drugs. Similarly, Robert et al. observed an increase in the implementation of isolation precautions with the implementation of information on the need of contact precautions provided with every MRSA-positive bacteriological result [19]. An MDR bacterium was less frequently reported in P. aeruginosa cases.
Hygienic measures for infections or colonization with multiresistant gram-negative rods: Recommendation of the Commission for Hospital Hygiene and Infectious Disease Prevention (KRINKO) at the Robert Koch Institute (RKI)
2012, Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz