Infection Prevention Strategies in Out-Patient Settings

Purpose:
To examine the effectiveness of nosocomial or hospital acquired infection prevention strategies in an outpatient rehabilitation setting given the frequency of patient visits and relative increased vulnerability of rehabilitation patients to infectious illnesses and diseases.

Background/Significance:
Nosocomial infections result in 25 thousand deaths each year. Researchers argue that one third of these deaths are preventable via behaviors such as frequent hand washing in in-patient settings but little research is being conducted in outpatient settings such as rehabilitation. These areas are potential sites for exposure to infectious illnesses such as influenza and pneumonia among others and outpatient patients and staff could potentially benefit from similar infection prevention strategies.

Methods:
A quasi-experimental pre-post design included assessment of the frequency of hand washing among rehabilitation patients at baseline and post four nosocomial infection prevention strategies including 1) Provision of nosocomial infection education and signs, 2) “Bioderm” demonstration, 3) Nosocomial infection prevention video, and 4) Provision of hand sanitizer samples. Washing hands prior to rehab visits (washing in) was observed as well as washing hands prior to leaving the rehabilitation area (washing out). Mean frequencies of washing in and out were compared among 39 cardiac rehabilitation patient visits over 12 weeks. Changes were assessed using descriptive statistics and t-tests.

Results:
At baseline, an average of less than one patient washed in or out during an outpatient rehab visit. Post intervention 1, 2, 3, and 4, the mean frequency of washing in and out was increased to 10 (p = .037) and 10 (NS), 12 (NS) and 10 (NS), 11 (p = .01) and 10 (.05), and 9 (p= .00) and 8 (p = .03) respectively. Significant changes in frequency of washing in and out were observed post interventions 1, 2, 3, and 4, including a potential cumulative effect of the interventions suggested by decreasing p values. The proportion of patients washing in and out was increased from less than one percent to 20 percent post four interventions during the 12 week period.

Conclusions and Implications for Practice:
Outpatient areas are potential sites infection exposure. Many outpatients have compromised immune system function and infectious agents can be carried to and from other hospital areas. As a result, the assessment of infection prevention strategies in outpatient settings is relevant to examine.