Ward assessment of SmartIdeas Project: bringing source isolation to the patient

SummaryMost UK hospitals lack enough single rooms to provide source isolation for all infected patients. The aim of this study was to test prototype isolation systems on general wards together with specifically designed portable sink units and toilets. Questionnaires were offered to staff, patients and visitors covering ease of use and acceptability. A total of 53 patients were isolated, with concurrent collection of environmental samples and staff hand hygiene audit. Blocking of beds next to infected patients was avoided but patients and staff were concerned about limited space and communication. Hand hygiene compliance on entry or exit to/from an isolated bed space significantly improved [43/76 (56.6%) to 107/147 (72.8%), P < 0.05]. Although popular, the toilets were mechanically unreliable. Low levels of microbial contamination (<1–3.4 cfu/cm2) were present within all isolated bed spaces. The highest colony counts were obtained from high contact sites (e.g. remote controls). Meticillin-resistant Staphylococcus aureus (MRSA) was present at similar levels inside all systems. Although one system was designed to provide airborne as well as contact isolation, MRSA was isolated from air inside and outside the system suggesting poor efficiency of the air door. The finding was confirmed by aerobiology tests at the Health Protection Agency Laboratory, Porton Down, UK. A trial of redesigned units is required to establish efficacy (Trial Identifier: ISRCTN02681602).