WEST JERSEY, UK – Around 90% of the patients in the ICU’s at West Jersey Regional Medical Center were on contact precautions last fiscal year, but adherence to the strict isolation policy was far lower than desired.
“We had doctors, nurses, technicians, all coming in and out of the room using various non-approved techniques of contact isolation including holding their nose, closing their eyes, holding their breath, and of course the classic just putting their hands behind their backs,” nurse manager Frank Reynolds stated. “This was completely unacceptable with our anticipated imminent health accreditation bureau inspection.”
Mr. Reynolds took swift action. He circulated a survey among hospital workers and found that 99.5% of the time, the reason these various staffers were not adhering to protocol was technical difficulties with getting into a contact isolation gown.
“We had many workers complaint they could not find the appropriate cart outside the room, or that the cart was empty, or that some people could not figure out how to get the gown on their body. Still others complained that they did not like the color of the gowns and refuse to wear them. One stated they would not wear anything but the Dior gown. She has since been let go.”
Mr. Reynolds thus devised a Quality Improvement plan. “I sat down with 351 of the hospitals top administrators, and demanded that we hire professionals to sit outside the rooms on contact isolation and help put on and remove the gowns for people. This would eliminate many of the problems and allow staff to comply with the contact precautions.”
I journeyed to the ICU to see Reynolds’ plan in action. The wardrobe consultants stand dutifully outside the patient rooms. Mostly younger, they range in age from around early 20s to late 30s and dress quite well. When any staffer approaches to enter a room, they politely ask if they’d like help putting on their contact gown. No matter the reply, they then begin to rather forcefully dress the staffer in a contact gown.
They have become quite proficient at it, and can gown the entire SICU rounding team (18 people if you include medical students) in under 90 seconds. To minimize cross-contamination, the consultants are each assigned to only one room, and take hourly hygiene breaks where they “hit the showers”.
The plan worked quite well. After only one QI cycle, compliance with contact precautions, as monitored by teams of newly-hired Contact Compliance Administrators, increased dramatically from 17% to 97%.
Their success was not without some drawbacks, of course. Mr Reynolds explains, “We had to fire several doctors and nurses, myself included, to pay for all these new personnel. But to keep JCAHO happy, any price is worth paying!”
“There’s no definitive evidence yet whether the patients receive higher-quality care as a result,” Reynolds concluded, “but let’s be honest, nothing matters as much as compliance.”