Reengineering the patient's environment: Establishment of a “Red Box” to improve communications with patients on isolation precautions

Malhotra, Prashant; Khameraj, Aradhana; Salim, Tanzila; Armellino, Donna; Susan, Wirostek; Epstein, Marcia; Farber, Bruce F.

doi:10.1016/j.ajic.2018.09.007

Cited by 8 publications

(5 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We found that Candida species contamination was more common on high-touch surfaces in close proximity to patients (3.1% contamination on surfaces <3 feet from the patient and 0.7% on surfaces >3 feet from the patient). Surfaces in close proximity to patients may be more frequently contaminated than more distant surfaces in patient rooms [25, 26]. In addition, it has been demonstrated that during procedures shedding of methicillin-resistant Staphylococcus aureus (MRSA) by colonized patients occurs significantly more often on surfaces less than 3 feet versus greater than 3 feet from the patient [27].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, it has been demonstrated that during procedures shedding of methicillin-resistant Staphylococcus aureus (MRSA) by colonized patients occurs significantly more often on surfaces less than 3 feet versus greater than 3 feet from the patient [27]. Therefore, it has been proposed that personnel remaining in more distant lower-risk areas of contact precautions rooms might not be required to wear personal protective equipment if they do not contact surfaces [25, 26].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Environmental Contamination with Candida Species in Multiple Hospitals Including a Tertiary Care Hospital with a Candida auris Outbreak

Kumar

Eilertson

Cadnum

et al. 2019

PAI

View full text Add to dashboard Cite

Background:Environmental sources have been implicated as a potential source for exogenous acquisition of Candida species, particularly the emerging multidrug-resistant Candida auris. However, limited information is available on environmental reservoirs of Candida species in healthcare facilities.Methods:During a 6-month period, cultures for Candida species were collected from high-touch surfaces in patient rooms and from portable equipment in 6 US acute care hospitals in 4 states. Additional cultures were collected from sink drains and floors in one of the hospitals and from high-touch surfaces, portable equipment, and sink drains in a hospital experiencing an outbreak due to C. auris. Candida species were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectometry.Results:Candida species were recovered from patient rooms in 4 of the 6 hospitals. Seven of 147 patient room cultures (4.8%) and 1 of 57 (1.8%) portable equipment cultures were positive, with the most common species being C. parapsilosis. For the hospital where additional sites were sampled, Candida species were recovered from 8 of 22 (36.4%) hospital room floors and 4 of 17 (23.5%) sink drains. In the facility with a C. auris outbreak, Candida species were frequently recovered from sink drains (20.7%) and high-touch surfaces (15.4%), but recovery of C. auris was uncommon (3.8% of high-touch surfaces, 3.4% of sink drains, and 0% of portable equipment) and only present in rooms that currently or recently housed a patient with C. auris.Conclusion:Candida species often contaminate surfaces in hospitals and may be particularly common on floors and in sink drains. However, C. auris contamination was uncommon in a facility experiencing an outbreak, suggesting that current cleaning and disinfection practices can be effective in minimizing environmental contamination.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Environmental Contamination with Candida Species in Multiple Hospitals Including a Tertiary Care Hospital with a Candida auris Outbreak

Kumar

Eilertson

Cadnum

et al. 2019

PAI

View full text Add to dashboard Cite

show abstract

“…This meant that family‐centred care and communication practises were reduced, leading to psychological distress amongst relatives 26–29 . Furthermore, it has been found that isolated patients have fewer visits from health care personnel, and as such, care is negatively affected by isolation precautions 30 . Also, PPE may cause reduced speech intelligibility, leading to miscommunication between health care staff, which can result in potentially fatal errors, for example, in acute situations like intubation 31 .…”

Section: Introductionmentioning

confidence: 99%

“…[26][27][28][29] Furthermore, it has been found that isolated patients have fewer visits from health care personnel, and as such, care is negatively affected by isolation precautions. 30 Also, PPE may cause reduced speech intelligibility, leading to miscommunication between health care staff, which can result in potentially fatal errors, for example, in acute situations like intubation. 31 Overall, the evidence presented suggests that isolation regimes and the use of PPE have a negative impact on patients, relatives and health care personnel.…”

Section: Introductionmentioning

confidence: 99%

Nurses' experiences of the phenomenon ‘isolation communication’

Holm

Dreyer

2022

Nursing in Critical Care

View full text Add to dashboard Cite

BackgroundCommunication with patients and relatives can be a challenge in the intensive care unit (ICU) setting because of the acute and critical situation. However, when caring for patients with infectious diseases like COVID‐19, nurses' communication is challenged further due to the required use of personal protective equipment (PPE) and mandatory isolation regimes.AimTo explore nurses' experiences of communicating while wearing PPE during COVID‐19 isolation precautions in the ICU.Study DesignA qualitative study within the phenomenological‐hermeneutic tradition. Data were collected via 12 interviews with nurses working in a Danish ICU from September to November 2020. Data were analysed using a Ricoeur‐inspired text interpretation method.FindingsThree themes emerged during the analysis: (1) communication was limited and distanced and nurses had to compromise; (2) the nurses' senses were reduced, and verbal and nonverbal communication practises changed; and (3) patients' and relatives' communicative vulnerability were exposed in an extraordinary situation.ConclusionThe analysis revealed a phenomenon that can be described as ‘isolation communication’. The isolation precautions and use of PPE had a profound impact on the nurses' caring and communicative practices, which were limited in this situation. The nurses found themselves physically, emotionally and socially distanced from the patients, relatives and their colleagues. However, to prevent the spread of the virus, isolation communication is something that the nurses have to endure.Relevance to Clinical PracticeAs our findings show that the nurses' communicative practises had to change during isolation communication, it is important for clinical practise and education to focus on implementing communication methods that optimise message transmission between ICU clinicians, patients and relatives in conditions requiring PPE and isolation. We should also focus on how to optimise interdisciplinary health communication in this situation.

show abstract

“…1 Use of the red-box strategy has been shown to improve isolation practices and to be cost-effective through preservation of PPE. [1][2][3][4][5] Prior studies have used direct observers to document compliance with PPE protocols [2][3][4][5] ; however, the method has multiple limitations. 6,7 We used remote video auditing to compare the rates of HCP compliance with infection prevention protocols in isolation rooms with and without the red box.…”

mentioning

confidence: 99%

Evaluating compliance with infection prevention protocols in red-box rooms via remote video auditing

Singh

Malhotra

Khatri

et al. 2021

Infect. Control Hosp. Epidemiol.

Self Cite

View full text Add to dashboard Cite

The timing of the positive result did not show a trend. Furthermore, 2 employees tested positive at initiation of the protocol: 1 was asymptomatic and 1 with mild symptoms. Of the remaining 3 employees, 2 developed symptoms and tested positive on the second test. The last employee remained asymptomatic and tested positive on the final test in the protocol.The cycle threshold (Ct) values for the asymptomatic individuals were 37 and 38, and the Ct values were 21, 26, and 30 for the symptomatic employees (Table 1). These relatively high Ct values are consistent with reports that viral loads, as measured by Ct values, are lower >12 days after mRNA vaccination compared to nonvaccinated individuals. 7 All 5 vaccinated employees who tested positive had a domestic partner as the positive household contact. None of employees who were exposed to a positive child or nonsignificant other adult became infected. Spousal relationship has previously been shown to be a high risk for secondary infection, with a mean household secondary attack rate of spouses of 37.8% in prevaccination data. 8 In our limited sample, the rate of secondary infection in vaccinated healthcare workers when exposed to a SARS-CoV-2-positive partner was 22.7%, which represents a significant risk of infection.Although our study had a small sample size, the data demonstrate a persistent risk of acquisition of infection following exposure to a household member, particularly a partner with COVID-19. None of the vaccinated employees developed severe disease, which is encouraging but could also be due to risk profile. Further research into COVID-19 after vaccination is needed, including the likelihood of transmission by fully vaccinated, asymptomatic individuals in different settings.

show abstract

Reengineering the patient's environment: Establishment of a “Red Box” to improve communications with patients on isolation precautions

Cited by 8 publications

References 17 publications

Environmental Contamination with Candida Species in Multiple Hospitals Including a Tertiary Care Hospital with a Candida auris Outbreak

Environmental Contamination with Candida Species in Multiple Hospitals Including a Tertiary Care Hospital with a Candida auris Outbreak

Nurses' experiences of the phenomenon ‘isolation communication’

Evaluating compliance with infection prevention protocols in red-box rooms via remote video auditing

Contact Info

Product

Resources

About