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On-site droplet precautions safe for respiratory tract infections
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Researchers implemented on-site droplet precautions for patients with respiratory infections at four rural hospitals in Switzerland, instead of single-room isolation, and found that the strategy was comprehensive, safe and acceptable.
Writing in Infection Control & Hospital Epidemiology, Rami Sommerstein, MD, an internal medicine and infectious diseases specialist at Bern University Hospital in Bern, Switzerland, and colleagues explained that in 2016, their unit became responsible for the oversight of infection prevention for the newly formed Bern University Hospital Group, which includes four rural hospitals. The rural hospitals had no plan to prevent nosocomial transmission of respiratory viruses, creating an opportunity for the researchers to develop a new strategy.
“Isolation in a single room is recommended for all patients with suspected and confirmed respiratory tract infections,” they wrote. “The evidence base for these measures, however, is low.”
Therefore, they developed a strategy for droplet precautions on-site, and the concept was implemented at all four rural hospitals in November 2017.
The researchers marked patients’ beds with a “droplet precautions on site” sign, and isolated them at their bed, instead of relocated them to a single room. Hand hygiene, gloves and gowns were required for contact with body fluids or substances, and all staff and visitors were required to wear surgical masks. In shared rooms, curtains or screens were used to prevent droplet contamination of the patient’s surroundings, according to the study.
“We assessed the health care worker (HCW) comprehension, safety, and acceptance of the concept by a survey and analyzed whether the concept increased sick leaves among hospital employees,” Sommerstein and colleagues wrote.
They conducted two examinations at the end of the 2017-2018 influenza season to evaluate the strategy.
According to the study, 47 of 55 surveys were completed, resulting in a response rate of 85%. Of the respondents, 85% indicated they understood the concept of on-site droplet precautions “well or very well,” 70% said the strategy was “safe or very safe,” and 60% said their acceptance of the new concept was “good or very good.”
The researchers noted that executive employees described the implementation process as “more adequate” (P = .04), rated patient compliance to on-site droplet precautions as “marginally better” (P = .05), and found the strategy “more recommendable” (P = .04) compared with nonexecutive employees. Male respondents indicated quicker familiarity with on-site precautions compared with female respondents, according to the study (P = .02).
Although the new concept was well received by HCWs and no increased risk for employee illness was observed, Sommerstein and colleagues said “more detailed investigations” are needed.
“In the meantime, we cautiously conclude that this pragmatic approach of on-site droplet precautions could be an alternative for all hospitals that lack a prevention strategy for nosocomial respiratory viruses, that do not dispose of single rooms for isolation, or that are experiencing a shortage of single rooms,” Sommerstein and colleagues wrote. – by Marley Ghizzone
Disclosures: The authors report no relevant financial disclosures.
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