Duke ICPs work to remove stigma of patient isolation
Duke ICPs work to remove stigma of patient isolation
Don’t just isolate — educate
There is an increasing emphasis in infection control on doing active surveillance cultures and detecting and isolating patients colonized with pathogens such as vancomycin-resistant enterococci (VRE).
Such efforts certainly can prevent transmission by detecting and isolating those colonized with VRE. But what about the stigma and educational issues raised by increasing the number of patients under contact isolation?
Infection control professionals at Duke University Medical Center in Durham, NC, are directly addressing that issue by designing education programs for both nursing staff and patients.
"The patients do start to feel a stigma," says Sharon Evans, RN, an ICP at Duke. "It’s something that I stress to the nurses, You are isolating the organism. You are not isolating the patient.’"
Patients are given an educational brochure that answers common questions about the reason for isolation, family issues, and whether they can leave their rooms.
"We have a protocol so that the patients can get out and they are not stuck in their rooms all of the time," she says. "If they want to get out and walk in the halls, they can do that. There are certain limitations while they are in the hospital, but I talk to the patients and their families about that and also what they can do at home."
The patient education component is part of an active surveillance program at the medical center to detect VRE. The need for active surveillance was underscored when VRE began increasing in a hematology-oncology ward.
"We had a couple of blips on our oncology unit where we would have VRE endemic outbreaks," Evans says. "All of a sudden within a short amount of time, we would have a cluster of VRE in urine or the bloodstream, and we couldn’t figure out why."
Evans decided to implement an active surveillance program to detect the reservoir of VRE circulating within the facility. Under the protocol, VRE screening was done on patients who had been in the hospital more than 72 hours; patients with prior health care exposure (within the prior 30 days); and patients with a known history of VRE. Patients with cultures positive for VRE remained in or were placed in contact isolation. Isolation was removed for those who had been isolated if they screened VRE negative.
In March 2002, the active surveillance protocol was implemented. Over the next six months, 75 screening rectal cultures were sent, with 16 (21%) screening cultures positive for VRE.
During this period, nosocomial VRE rates decreased to 1.6/1,000 patient days (a 34% decrease).
Active surveillance for VRE for high-risk patients had a significant impact on limiting the spread of VRE by detecting and isolating patients that would have otherwise been missed.
"We would have missed a lot of them," Evans says. "We would have treated them just like regular patients not knowing they were colonized with VRE and spreading it."
There is an increasing emphasis in infection control on doing active surveillance cultures and detecting and isolating patients colonized with pathogens such as vancomycin-resistant enterococci (VRE).Subscribe Now for Access
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