Prevention of respiratory outbreaks in the rehabilitation setting

[摘要] Background Respiratory viral (RV) outbreaks inrehabilitation facilities can jeopardise patient safety,interfere with patient rehabilitation goals and cause unitclosures that impede patient flow in referring facilities.Problem Despite education about infection preventionpractices, frequent RV outbreaks were declared each yearat our rehabilitation facility.Methods Before and after study design. The primaryoutcome was the number of bed closure days due tooutbreak per overall bed days. Process measures includeddelays in initiation of transmission-based precautions, RVtesting and reporting of staff to occupational health andsafety (OHS). Balancing measures included the number ofisolation days and staff missed work hours.Interventions Based on comprehensive analysis of prioroutbreaks, the following changes were implemented:(1) clear criteria for initiation of transmission-basedprecautions, (2) communication to visitors to avoidvisitation if infectious symptoms were present, (3)exemption of staff absences if documented due toinfectious illness, (4) development of an electronicprogramme providing guidance to staff about whether theyshould be excluded from work due to infectious illness.Results The number of bed closure days due to outbreakper overall bed days dropped from 2.8% to 0.5% duringthe intervention season and sustained at 0.6% duringthe postintervention season (p<0.001). There were fewerdelays in initiation of droplet and contact precautions(28.8% to 15.5%, p=0.005) and collection of RV testing(42.9% to 20.3%, p<0.001), better reporting to OHS(9 vs 28.8 reports per 100 employees; p<0.001) andfewer isolation days (7.8% vs 7.3%; p=0.02) without asignificant increase in missed work hours per 100 hoursworked (4.0 vs 3.9; p=0.12).Conclusion This Quality Improvement study highlights theprocess changes that can prevent respiratory outbreaks inthe rehabilitation setting.

[学科分类] 药学