Is evidence guiding practice? Reported versus observed adherence to contact precautions: A pilot study

BackgroundHospital-acquired infections are a major patient safety issue. We examined staff members' knowledge, attitudes, reported and observed adherence to guidelines, and perceptions of barriers to use of contact precautions.MethodsA survey and nonparticipant observation study was used to examine knowledge, attitudes, perceptions, and actual behavior of staff on 3 medical/surgical units at a 600-bed Magnet-designated academic medical center (MDAMC) and a 110-bed community medical center (CMC) in the southeastern United States.ResultsCorrect knowledge answers ranged from 75% (CMC) to 100% (MDAMC). CMC participants were less likely to perceive time as a barrier (5% vs 25%; P = .050); more MDAMC participants were motivated by supervisors' recognition (87% vs 33%; P = .001). No statistically significant differences existed between groups on reported behaviors. Upon observation, fewer CMC participants demonstrated 4 of 5 evidence-based contact precaution behaviors compared with MDMC participants (P < .001). Hand hygiene before glove application was similarly low at both sites.ConclusionsDespite a decade of focus on improving patient safety, low adherence to evidence-based practice guidelines for implementation of contact precautions remains. Ongoing efforts are needed both at the system and practitioner level to improve practice adherence.