Contact precautions for multidrug resistant bacteria: positive impact on handwashing compliance in an intensive care unit

Introduction

Critical patients are highly susceptible to acquiring both infections and multidrug-resistant bacteria in the ICU. Handwashing compliance practices are generally low, particularly in ICUs, and contact precautions are recommended to reduce transmission of selected micro-organisms between patients. Although widely used, little is known about the effect of contact precautions on hand-washing practices.

Objective

Our objective was to compare hand-washing compliance in patients under contact precautions with patients under standard precautions in a medical-surgical ICU.

Patients and method

Hand-washing opportunities were defined according to Institutional guidelines and patients infected or colonized with multidrug-resistant bacteria (methicillin-resistant S aureus, Acinetobacter, Gram-negative bacteria resistant to carbapenens/cef-tazidime and vancomycin-resistant Enterococcus) were isolated and contact precautions were instituted. Patients on routine standard precautions served as controls. Hand-washing compliance was recorded with prospective direct observation by trained personnel without the knowledge of the multidisciplinary team.

Results

During two distinct periods (September 1999 and May 2000), 543 hand-washing opportunities were observed for a general compliance rate of 45.1% (before and after patient care). Compliance was higher after than before patient care (71% × 20.3%, OR 10.09, 95% CI 6.6-15.33). Compliance was higher during care of patients under contact isolations (54.9 × 36.2%, OR 2.14, 95% CI 1.49-3.04; P = 0.00002), which was mainly due to hand-washing after patient care (87.6% × 56.3%, OR 5.52, 95% CI 2.86-10.78; P = 0.000001). Higher compliance was observed for nurses (57.5%).

Conclusion

Hand-washing compliance in our ICU is low and comparable to rates described in the medical literature. Contact precautions for patients colonized/infected with multidrug-resistant bacteria significantly enhances hand-washing compliance practices, mainly after patient care. A careful evaluation should be focused on other beneficial effects of strict contact isolation policies, such as decreasing rates of nosocomial infections or lower rates of recovery of multidrug-resistant organisms.