Prevention of respiratory outbreaks in the rehabilitation setting

Corpus, Carla; Williams, Victoria; Salt, Natasha; Agnihotri, Tanya; Morgan, Wendy; Robinson, Lawrence; Maze Dit Mieusement, Lorraine; Cobbam, Sonja; Leis, Jerome A

During implementation of the four process changes, 74% (128/172) of nursing staff were trained regarding criteria for initiation of transmission-based precautions, including 81% (60/74) of full-time staff. Figure 1 depicts the monthly proportion of patients placed on droplet and contact precautions and figure 2 shows the monthly proportion tested with MT swabs for respiratory viruses greater than 24 hours after onset of symptoms. A shift in practice was noted following training with significant reductions in delays in both initiation of droplet and contact precautions (15.5% vs 28.8%; p=0.005) and viral testing (20.3% vs 42.9%; p<0.001) in the intervention respiratory season and onward. Table 2 summarises the family of measures during the intervention and postintervention seasons compared with the baseline season. The number of bed closure days due to outreak adjusted for overall bed days dropped from 2.8% to 0.5% during the intervention season and was sustained at 0.6% during the postintervention season (p<0.001). Staff reporting to OHS increased from 9 to 28.8 per 100 employees (p<0.001). In terms of unintended consequences, earlier initiation of droplet and contact precautions did not lead to increased isolation days. In fact, the proportion of isolation days per patient days decreased during the intervention season as compared with baseline (7.3% vs 7.8%; p=0.02). With regard to potential for increased absenteeism, there was no significant change in the number of missed work hours for employees (4.0 missed hours/100 worked hours at baseline vs 3.9 missed hours /100 worked hours during intervention; p=0.12).