Abstract
To prevent transmission of multidrug-resistant organisms (MDROs), establishment of both contact precaution and environmental measures is recommended. However, adherence to these measures in clinical practice has not been evaluated in Japanese health-care institutions. The present study evaluated how health-care personnel follow the contact precaution protocols recommended by the CDC guidelines during care for patients colonized and/or infected with MDROs in Japanese acute-care facilities. Data related to adherence to contact precautions was collected at five tertiary care hospitals by direct observation by certified nurses in infection control (CNIC), who evaluated hand hygiene, wearing gown and gloves immediately before room entry of patients colonized/ infected with MDROs, discarding gown and gloves when leaving, followed by hand hygiene. In addition, the CNIC asked each member of staff in charge of the patients with MRDOs how environmental measures are followed. The Ethic Review Boards of International University of Health and Welfare as well as five tertiary care hospitals approved this study. A total of 1468 scenes were observed. Overall adherence rates to contact precautions at five hospitals were as follows: 52.8% for hand hygiene before room entry; 68.9% for glove wearing; 65.8% for glove disposal; 78.7% for gown wearing; 75.1% for gown disposal; and 75.5% for hand hygiene when leaving the patient's room. Adherence rates for hand hygiene before room entry were significantly greater in the ICU and ER, compared to other units (46.0%, p<0.001). Adherence rates of physicians for all contact precaution protocols were significantly lower than for other health-care personnel (31.5%–60.8%, p<0.001). The averages of adherence rates of cleaning measures for high-frequency contact surface points in the patient's environment at the five hospitals were 85.9% to 100%. Based on the findings of this study, we could conclude that recommended environmental measures required for patients colonized/ infected with MRDOs were fully followed by health-care personnel. However, we found that the adherence rate to hand hygiene by health-care personnel who wore gloves before room entry was low. To increase adherence to the contact precautions recommended by the CDC guidelines, systems for regular monitoring of contact precautions and feedback are essential.
