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Nurse’s Perceptions of Visitor’s Adherence to Transmission-Based Precautions

Transmissions based precautions are measures implemented in various clinical health care settings as a means to prevent the transmission of infectious diseases and decrease instances of healthcare acquired infections (HAI). HAI’s result in increased cost to hospitals, longer hospitalization for patients, increased patient suffering, and fatal patient outcomes. While staff member adherence to transmissions based precautions are mandated through various organizations and hospital policies, a review of literature indicates little research has been conducted regarding visitor compliance with transmission-based precautions. The potential implications in healthcare from visitor non-adherence acquired infections are unknown; revealing a gap in literature and supporting the need for further research to describe the phenomenon. Through utilization of a descriptive online survey instrument, the purpose of this descriptive study is to gain insight into why nurses believe visitors may or may not be compliant with transmission-based precautions. To collect the data, an online descriptive survey instrument was developed and distributed via email to all graduate students’ enrolled East Tennessee State University’s College of Nursing. Only ten participants met the eligibility requirements to participate in this study. Data was analyzed though a predictive analytics software and grouping responses into themes. Responses suggest that nurses feel visitors are not complying with transmission-based precautions because of a lack in education, not perceiving the infection as a threat, prior exposure to loved one at home, and inconvenience. 2 Running head: NURSE’S PERCEPTIONS OF VISITOR’S ADHERENCE TO TRANSMISSION-BASED PRECAUTIONS Background Healthcare acquired infections (HAI) are infections which were not present in a patient at the time of hospital admission. A HAI is a result of a patient being exposed to a given organism during their hospital stay. HAI’s have many repercussions which include increased patient discomfort, increased length of hospitalization, and increased patient mortality rates (Centers for Disease Control and Prevention [CDC], 2014). Additionally, HAI’s have significant financial ramifications and substantial increase in hospitalization cost (Scott, 2009). According to the Centers for Disease Control (CDC, 2014), on any given day it is estimated that about 1 in 25 patients have at least one HAI. In 2011, it was estimated that approximately 722,000 HAI’s had occurred within United States acute care hospitals (Centers for Disease Control and Prevention [CDC], 2014). In 2011, it was estimated that 157,500 HAI’s resulted in pneumonia, 123,100 HAI’s resulted in gastrointestinal illness, 93,300 HAI’s resulted in urinary tract infections, 71,900 HAI’s resulted in bloodstream infections, 157,500 HAI’s resulted in surgical site infections from inpatient surgery, and roughly 118,500 HAI’s resulted in other various types of infections (Centers for Disease Control and Prevention [CDC], 2014). Furthermore, it is estimated that in 2011, 75,000 patients with a HAI died during the time of their hospitalization (Centers for Disease Control and Prevention [CDC], 2014). The financial burden of a patient acquiring a HAI’s weighs heavily on the hospital facility. As Medicare, Medicaid, and insurance companies will not pay for HAI’s, the hospital is responsible for the cost of extended care. In 2007, it was estimated that the financial implication of HAI’s cost United States inpatient hospitals anywhere from $35.7 billion to $45 billion annually (Scott, 2009). 3 Running head: NURSE’S PERCEPTIONS OF VISITOR’S ADHERENCE TO TRANSMISSION-BASED PRECAUTIONS Transmission-based precautions are used as a barrier within a health care setting to break the chain of infection and decrease the instance of HAI’s among patients. The chain of infection involves an infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and a host (Potter & Perry, 2013). If one link of the chain is broken, the infection cannot continue and therefore the spread of infection becomes halted. Transmission-based precautions are used to break the chain of infection at the mode of transmission and portal of entry by using personal protective equipment (PPE) to act as a barrier. Transmissions based precautions are divided into the following categories: contact, droplet, and airborne (Potter & Perry, 2013). Contact precautions are used in direct and/or indirect contact with patients and the environment around them. Contact precautions require the use of a gown and gloves as PPE when in close contact with an infected patient or a patient suspected of infection. This type of transmissions based precaution works to break the chain of infection through reducing instances of contact with contaminated bodily fluid or organisms lying on the skin. Patients placed under contact precautions may be infected with colonization or infection of multi-resistant organisms such as Vancomycin-resistant enterococcus (VRE), Methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile, Shigella, or many other wound infections such as Herpes Simplex and scabies. Not only does adherence to contact precautions halt the spread of infection among patients, it provides protection to health care staff as well (Potter & Perry, 2013). Droplet precautions are used to prevent diseases that are transmitted through large particles that can be expelled into the environment and travel 3-6 feet from the point of expulsion (Potter & Perry, 2013). Droplet precautions require the use of a surgical face mask with a face shield as PPE when with dealing contaminated patients. Patients placed under droplet precautions may be infected with Influenza, Adenovirus, Respiratory Syncytial Virus, Human 4 Running head: NURSE’S PERCEPTIONS OF VISITOR’S ADHERENCE TO TRANSMISSION-BASED PRECAUTIONS Metapneumovirus, and Bordetella pertusis (Centers for Disease Control and Prevention [CDC],