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Epidemiology of isolation precautions.

OBJECTIVE
To investigate compliance with isolation precautions.


DESIGN
A prospective observational study carried out during ten weeks of 1989. Participants were unaware of the study.


SETTING
The isolation bay of a 24-bed surgical intensive care unit in a 900-bed university tertiary care facility.


PARTICIPANTS
Study participants included any healthcare worker or visitor entering the patient room during designated 15-minute intervals.


RESULTS
We observed 467 subjects entering patient rooms. Compliance with strict isolation (65%) was better than with wound/skin (40%) or excretion/secretion (36%) isolation (p less than .01). Visitors were more compliant than healthcare workers (88% versus 41%; p less than .01). Spending more time in the room was associated with improved compliance (p less than .01). Compliance was higher for subjects entering with a group compared with those entering alone (51% versus 41%; p less than .05). The compliance rate for nurses improved as the nurse/patient ratio improved (p = .14). Compliance was independent of severity of illness. Multivariate analysis revealed that the amount of time spent in the room, being a visitor, and use of strict isolation were independent predictors of compliance.


CONCLUSIONS
Noncompliance was widespread. When increased demands are placed on the time of physicians and nurses in the name of cost containment, unperceived consequences, such as those resulting from decreased compliance, must be considered.