The Green Zone: Revising Workflow to Improve Patient Safety

Purpose:
Does the use of a “zone” that does not require donning of personal protective equipment with contact isolation patients increase nursing time with patients?

Background/Significance:
The Centers for Disease Control and Prevention recommend the use of Standard and Contact Precautions for multidrug-resistant organisms. Studies have assessed the unintended impact of isolation on patients and providers. A systematic review by Abad, Fearday and Safdar (2010) found that “contact isolation may negatively impact several dimensions of patient care”, including time spent in direct care, psychological negative effects including depression and anxiety, and patient safety.

Methods:
A quasi-experimental quantitative pilot (n=41) research study investigated the frequency and amount of time nursing staff was in direct contact with medical patients. The categorical independent variable is the Contact vs. Non-Contact Isolated patient. The dependent variable is continuous and is the time in direct patient contact. A Green Zone (an area marked on the floor inside the patient room) allowed face to face (no touch) contact with the patient. Healthcare providers entered the Green Zone to talk with the patient without donning gowns/gloves. Frequency and duration of time spent with an isolation patient and non-isolation control patient was collected pre and post Green Zone.

Results:
Data analysis was completed with SPSS. The number of contacts decreased post intervention (12.84 to 6.64, p=.00). The average minutes per contact increased post intervention (7.15 to 8.22 minutes, p=.237). For all patients there was a 1.07 minute/hour increase in contact time post intervention (7.80 to 8.87, p= .348). There was no significance on any variable for patients in isolations vs. non-isolation patients.

Conclusions and Implications for Practice:
Increased nursing time (25 minutes/day) with patients may be clinically significant, positively impacting isolation patients' physical, cognitive and emotional health. A larger study which analyzes patient safety quality indicators including falls and hospital acquired infections is recommended.