Elements of modified contact precautions
These are the contact precautions that were modified by infection control practitioners (ICPs) at the South Texas Veterans Healthcare System in San Antonio for use in its geriatrics and extended care programs to reduce the incidence of vancomycin-resistant enterococci (VRE) and other drug-resistant organisms:
• A private room or cohorting is preferred.
• If a private room or cohorting is not possible, VRE patients may be placed with patients not colonized with VRE under these specific conditions: no open, draining wounds; the noncolonized patient doesn’t have invasive catheters and is not immunocompromised; the VRE resident doesn’t have diarrhea; and both patients must have clean personal hygiene. The sharing of bathrooms is discouraged. A consult with an ICP is recommended.
• In addition to guidelines from the Centers for Disease Control and Prevention and the Society for Healthcare Epidemiology of America for hand washing and gloves, antimicrobial hand wash is recommended for both employees and VRE-colonized residents. Waterless alcohol foam soap is used after glove removal to enhance hand disinfection in areas where sinks are inaccessible.
• Wear gowns during direct care activities and when in contact with bedside equipment in patient rooms. Discard gowns before leaving patient rooms. Health care workers do not usually wear gowns when they are working around VRE residents outside of the patient’s room.
• Do not limit patient activity. Activity and movement are dictated by the rehabilitation treatment plan. Only patients who are incontinent and not contained with an adult diaper, have diarrhea, or have open, draining colonized/infected VRE wounds are limited to their rooms.
• Address special resident issues such as demen tia, wandering, or noncompliance through an ICP consult.
• If possible, dedicate equipment for single patient use, especially thermometers, wheel chairs, stretchers, and blood pressure cuffs. Rectal temperatures are not allowed. When dedicating equipment is not possible, disinfect it between patient use. Clean horizontal surfaces daily in the patient’s room with disinfectant approved by the U.S. Environmental Protection Agency.
• Education is a high priority with families, residents, and health care workers; it should be ongoing and consistent. Resident and family education should address VRE transmission, personal cleanliness, hand washing, and environmental cleanliness for the facility and home when the patient is discharged. Health care worker education should focus on those issues as well as unique issues defined by the patient assessment related to VRE transmission risks.
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