Abstract
Protecting patients when they are in highly vulnerable states is important for ensuring their recovery. In cardiac settings, the lack of public awareness about the precautions they can take to minimize the impact on the well-being of patients presents additional challenges for healthcare providers. Thus, the current teaching plan aims to inform healthcare setting visitors about appropriate precautions when entering isolated settings. A pamphlet with the vital information intends to serve as the main educational tool, which can be disseminated among visitors effortlessly. The close collaboration between visitors and hospital staff can help patients recover within appropriate environments, thus positively enhancing their quality of stay at healthcare facilities.
The safety of patients should always be a priority when it comes to maintaining relevant processes of care. The transmission of harmful bacteria and organisms is a topic of concern for patients and healthcare institutions, which calls for increased awareness of the problem. Depending on the type of bacteria transmission, such as droplet, contact, or airborne, relevant protection methods are necessary when it comes to preventing their transmission within hospital settings. The topic was chosen for further exploration because of the lacking education among hospital visitors regarding the ways in which they can shield patients from the potential impact of bacteria. Because education is the focus of the project, the aim is to develop a pamphlet that would include relevant information on isolation precautions.
Problem Statement
The lack of education on essential isolation precautions among hospital visitors represents the main problem in the current project. However, a large body of research shows that the transmission of harmful bacteria and organisms involves hands and clothes (Munoz-Price et al., 2015). If they remain unprotected without appropriate precaution procedures, visitors have a high likelihood of transferring bacteria to patients. The use of standard isolation procedures can reduce the role of visitors in the transmission of pathogens within acute or chronic health settings. Since the problem of lacking education is the key to the current project, the development of a tool that would increase the awareness of visitors is imperative.
Background
The importance of the problem is attributed to the need to establish solutions that would be easy to implement but would at the same time protect patients against potential pathogens. Notably, the medical-surgical (Medsurge) setting requires the establishment of methods that would guarantee the protection against pathogens. The unique quality of such environments is associated with multitasking and coordination on the part of nurses as they often care for several patients at once. Moreover, healthcare professionals working in Medsurge settings are required to work with a broad range of illnesses and conditions, and the risk of additional infections caused by environmental factors can make their work more complicated than necessary.
Therefore, to ensure that the work of nurses in such complex settings is not limited by additional constraints such as the risk of bacteria and pathogens brought by visitors. Raising awareness of the ways in which visitors can reduce their impact on the complex Medsurge environments is important, especially with the availability of convenient and easy ways to disseminate information. However, the information acquired in the course of the study can be applied to multiple healthcare settings.
Purpose
The main purpose of the project is to develop a solution to teach isolation precautions for visitors. Moreover, it is important to study the literature that focuses on the topic of isolation precautions to identify common themes and findings to support increased education. The idea of creating a pamphlet that would have relevant information on precautions stemmed from the need to ensure that the setting within which nurses operate does not only focus on care but also education. Before entering the setting, visitors can inform themselves about how they can safeguard patients from potential bacteria and pathogens. The information is necessary to ensure that visitors use isolation precautions every time they enter and leave healthcare settings.
The Nature of the Project
In order to determine the ways in which isolation precautions can be effectively embedded in the routine of hospital visitors, an informational pamphlet will be developed. In a Medsurge setting, informing visitors about important safety precautions is imperative because of the complexity of practice and the need to safeguard patients from additional health complications. A pamphlet is usually a small, unbound booklet that is used for providing information on a single subject. It is possible to create a pamphlet of any size and shape needed. Depending on the volume of information, they can include as many pages as needed.
In the chosen setting, pamphlets will play an educational role, which is widespread for healthcare organizations. When one enters a hospital, it is common to see pamphlets available at the reception area to inform visitors and patients about different topics, such as preventative health practiced and treatments, symptoms of specific illnesses and disorders, or explanations of particular tests and medical procedures. The purpose of such pamphlets is to inform, rather than to encourage the target audience to buy a specific product.
Despite the fact that most information is being digitalized and disseminated on the Internet, pamphlets can still provide value. First, they are cost-effective at both production and delivery stages. For healthcare facilities that do not have the resources to invest in costly informational tools, pamphlets can be good solutions for starting the integration of educational materials for visitors and patients. The objective of having pamphlets available is to show that the facility cares about the safety of patients and would like to open a conversation on effective precaution measures.
Printed pamphlets can make a lasting impression on visitors because the latter tend to preserve information that is printed on paper rather than available on the screen. If the booklet has a stand-out design and the information printed on it is precise and succinct, it will likely serve as a useful educational tool. Another important advantage of printed pamphlets is their portability so that they can be taken anywhere. Before leaving, visitors can take a pamphlet home to educate themselves on precaution measures that they can implement the next time they visit the setting.
There is also some potential for researching the impact of educational pamphlets on visitors. Hospital visitors can be interviewed on whether they learned important information on isolation and safety precautions with the help of the pamphlets. In addition, the impact of visual materials on the perceptions of visitors regarding isolation precautions can also be studied. It is important to determine whether the use of printed visual methods can be continued or whether it would be a better solution to implement web-based solutions.
An example of the pamphlet is presented below (Figure 1). It is expected that the pamphlet will have some images to attract the attention of the target audience. It is also important to have a bold headline communicating the key purpose of the informational piece. First, the pamphlet should communicate the main issue that the facility is currently facing, which is the lack of precaution measures when it comes to isolation practices. Second, the ways in which the problem will be addressed should be listed. Using a bullet-point format is easy to comprehend for a broad audience as well as is suitable for such informational tools as pamphlets.
Research Question
Since the primary goal of the project is to develop a solution that would enhance isolation precautions among hospital visitors, it is imperative to determine the perceptions of the latter regarding the effectiveness of the solution. By utilizing the PICO tool, it is possible to develop the key research question for the current study as well as indicate the intervention that will be used to solve the problem. The following is the proposed PICO question: Among hospital visitors (P), will the dissemination of educational pamphlets (I), compared to no educational efforts (C), increase the awareness of the target population on important isolation precautions?
The developed PICO question intends to compare the effectiveness of educational pamphlets available at hospitals against to solution at all. Based on the formulated main research question, it is possible to develop two sub-questions that will be explored in the study. They are the following:
- Are educational efforts for ensuring that hospital visitors implement isolation measures effective?
- What is the attitude of visitors toward the availability of educational materials?
It is important to note that the project has varied prospects for further research. Because education represents the key area for the study, it is also important to determine whether nurses operating within various settings could see the effects of spreading awareness regarding precaution practices among visitors. However, in the current research, the focus will be placed on the perceptions of visitors because they represent the target audience that has limited awareness of precaution procedures.
Summary
Educating visitors about important isolation measures they can implement when entering healthcare settings is essential. The current project aims to determine whether the dissemination of educational materials among hospital visitors would increase their adherence to isolation precautions. The latter is necessary for creating barriers between people and pathogens, which means that precautions are required for preventing the spread of germs within a healthcare setting.
The problem is especially relevant for Medsurge settings, which are characterized by the multi-dimensional nature of professionals’ work and the need to balance the care for several patients at the same time. It is essential that visitors understand the importance of isolation measures in such settings and help healthcare providers by limiting the risks of pathogen spreading within facilities. Overall, education on isolation prevention represents an aspect of general health literacy because it will encourage hospital visitors to be attentive to their actions when entering healthcare facilities.
Literature Review
Introduction
The intent of this chapter is to review relevant materials that could guide the implementation of the Capstone Project. As the principal purpose of the project is to develop a solution to implement effective isolation practices among hospital visitors, having support from the research literature is important. Moreover, the review of literature is necessary for identifying potential gaps that would serve as implications for future research on isolation precautions.
Historical Overview
Isolation precautions represent the set of practices to stop the spread of pathogens from one person to another. Such precautions have been used to protect patients, their families and visitors, as well as healthcare staff. The history of isolation techniques dates back to 1970, marking the publishing of Isolation Techniques for Use in Hospitals, 1st edition (CDC, 2015). The document introduced the implementation of seven precaution categories with color-coding. They included strict, respiratory, protective, enteric, wound and skin, discharge, and blood precautions (CDC, 2015). The techniques did not require any decision-making on the part of users, which made them simple to comprehend.
In 1983, the CDC Guideline for Isolation Precautions in Hospitals was established, differentiating between category- and disease-specific isolation practices. The guidelines emphasized the importance of decision-making by users, eliminated protective isolations, and expanded blood precautions to include body fluids (CDC, 2015). Later, the Universal Precautions of 1985-1988 were developed as a response to the epidemic of HIV/AIDS, thus dictating the adherence to blood and body fluid safety for all patients, despite their infection status (CDC, 2015). Moreover, the precautions included recommendations for the use of personal protective equipment to safeguard against pathogen exposure of the mucous membrane.
The 1996 Guideline for Isolation Precautions in Hospitals was developed by the Healthcare Infection Control Practices Advisory Committee (HICPAC) (CDC, 2015). It represented the combination of the critical features published in the previous precaution guidelines to develop a comprehensive approach toward lowering the spreading of pathogens at healthcare facilities. The Guideline included three categories of transmission-based precautions, such as airborne, contact, and droplet (CDC, 2015). In addition, it provided a list of clinical syndromes that should regulate isolation procedures until there is an etiological diagnosis for a patient.
The latest update on isolation precaution guidelines is the 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. It was developed by Siegel, Rhinehart, Jackson, Chiarello, and the Healthcare Infection Control Practices Advisory Committee, the Guidelines include the most current and relevant precautions for preventing the spreading of infectious diseases.
Moreover, since 2007, the Guidelines were updated with the latest recommendations for infectious conditions, viruses, and vaccines. For example, the Ebola Virus Disease Update was added in 2014 in order for the Guidelines to be relevant to the current practice despite being initially published in 2007 (Siegel et al., 2019). The need for continuous updates is associated with the changes in healthcare delivery and settings. This means that the revised guidelines should cover the broad range of healthcare delivery contexts and pathogen risks associated with them. Besides, the emergence of new pathogens, such as SARS-CoV, calls for the review of the existing isolation measures to make sure that the practices align with healthcare risks.
To summarize, the history of developing isolation precautions at healthcare facilities is attributed to changes in practice as well as the emergence of new risks for public health. Depending on the severity of infections and the methods of their transmission, relevant isolation precautions are recommended for implementation. The latest version of the 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings is intended to be used by infection control staff, nurses, epidemiologists, and other parties responsible for preventing the spreading of infections among the population (Siegel et al., 2019). However, it is imperative that not only healthcare staff is aware of isolation precautions but that patients and their visitors understand the importance of such measures.
Current Findings
General Information on Precautions
Current evidence from research points to the need for healthcare institutions to implement isolation precautions among visitors. As suggested by Munoz-Price et al. (2015), all visitors should be informed about the importance of hand hygiene before visiting a healthcare setting as well as immediately leaving it. The rationale for the rule is associated with the comprehensive means of reducing the pathogenic burden on hands as well as the prevention of pathogen transmission. This suggestion must be included in the educational pamphlet for potential hospital visitors as the main precaution for protecting patients against pathogens.
A significant contribution to educating patients about relevant precautions for isolation is attributed to Stockowski (2016) for The Society for Healthcare Epidemiology of America. The recommendations attempt to balance patient and visitor safety, reduce the potential of spreading pathogens within a healthcare facility, as well as consider the feasibility of isolation enforcement. According to Stockowski (2016), 77% of hospitals provide education on hand hygiene. In instances where Enterococcus (VRE) and Staphylococcus aureus (MRSA) are endemic, there may be no need to follow contact precautions. Although, when it comes to visiting patients with a challenged immune system, special considerations ranging from the use of gloves and gowns to limiting visitation should be put in place.
For patients with Norovirus and Clostridium deficit, which are intestinal pathogens, there is a high risk of infecting visitors, which suggests the use of contact precautions (Stockowski, 2016). In addition, it is imperative to consider the isolation precautions for visitors who come to see patients with highly “drug-resistant gram-negative organisms (for example, Klebsiella pneumoniae carbapenemase) in order to prevent transference of pathogens to visitors” (Stockowski, 2016, p. 6). Therefore, isolation precautions are relevant not only in the context of visitors bringing in potential pathogens from the environment but also for safeguarding the latter against
When it comes to visitors to rooms with an increased risk of droplet-related pathogen transmissions, it is recommended to wear surgical masks. Visitations by any ill individuals or patients’ family members, which exhibit signs of illness such as fever and active cough, should not be allowed to enter the settings to reduce the risk of infecting not only patients but also other visitors and personnel.
Importantly, considering the practicality of isolation practices should rely on the nature of visits. For instance, among visitors of patients that plan extended stays in patients’ rooms, including overnight visitations, isolation procedures may not be practical. The likelihood of potential bacteria transfers can decrease if visitors practice good hygiene as well as wear gloves and gowns in scenarios of prolonged stays (Munoz-Price et al., 2015). Depending on the condition of patients, limiting entrance may be used as a temporary tool until the condition of the latter improves.
Importance of Visitor Education
The body of evidence presented in the previous section pointed out important precautions that visitors can take when entering a healthcare setting. However, special attention should be placed on the importance of visitor education because knowledge can be a useful tool for safeguarding patients, visitors, and staff. The study by Wolfensberger et al. (2019) revealed that an edutainment video could be a useful tool for informing a target audience about the importance of standard precautions as well as the ways of their implementation. As mentioned by the researchers, “satisfaction with the learning method was superior in the video group, suggesting higher potential for future uptake” (Wolfensberger et al., 2019, p. 1). Therefore, visual materials show to be more effective for educating audiences.
The importance of educating patients and hospital visitors on the measures of hygiene has been attributed to the need to create safe and pathogen-free environments. Görig et al. (2019) integrated the AHOI (“Activation of patients, persons in need of care and caregivers for a Hygieneconscious participatiOn in Infection control) approach for increasing the adherence of patients and relatives to self-reported hand hygiene” (p. 1).
The strategy implied the giving out of an AHOI-welcome-box to patients and visitors that included both educational and informative materials of hand hygiene. Also, education was supported by visual materials, such as posters in patients’ rooms and sanitary facilities.
When surveying hospital patients upon admission, it was revealed that more than a third of participants expected to receive negative feedback from staff members after hygiene deficiencies were identified. This points to the necessity of nurses to collaborate with staff and when it comes to adherence to hygiene measures. Görig et al. (2019) found that when deficiencies in hygiene were identified with hospital staff, patients reported positive reactions once they communicated the issues to personnel.
The feeling of active involvement in the efforts of increasing isolation and hygiene procedures adherence showed to be positively correlated with personal hygiene practices such as hand disinfection. Therefore, making sure that both patients and visitors who come to healthcare facilities adhere to the established rules of isolation and hygiene.
Munoz-Price et al. (2015) underlined the importance of using isolation precautions among visitors at hospitals. The guidelines that the researchers developed for the Society for Healthcare Epidemiology of America (SHEA) are intended to assist healthcare facilities in either creating or modifying policies regarding visitor isolation procedures. The recommendations were mainly meant to both pediatric and adult acute care settings, although they may be used in other circumstances.
However, despite underlining the importance of contact precautions for hospital visitors, Munoz-Price et al. (2015) did not provide recommendations on educating visitors about isolation precautions that they can implement. The study is relevant to the current research because it offers a comprehensive perspective on the need to implement the measures of precaution for hospital visitors. It can be enhanced by studying the effects of educational interventions on the adherence of visitors to isolation precautions.
Improving adherence to safety and isolation precautions is necessary for controlling healthcare-associated infections. Interventions that target the improved effectiveness of adherence should predominantly include educational efforts. According to Moralejo, El Dib, Prata, Barretti, and Corrêa (2018), who explored studies on supporting adherence to safety precautions, education and visualization, compared with no intervention, increased the awareness on how to decrease the risks of potential infection transmission in healthcare settings.
The study is important for the current research project because pamphlets represent visual materials that can be quickly disseminated across a healthcare setting to educate visitors and patients. Using the evidence provided by Moralejo et al. (2018), it is possible to develop a unique approach toward visitors’ education on isolation precautions. Depending on the practice setting and the method in which pathogens can potentially spread, appropriate educational measures should be put in place.
In addition, it is imperative to take into account the effects of peer evaluations as control tools for improving the adherence of healthcare workers to standard precautions. Colored cues and checklists may also influence improved adherence procedures; however, the certainty of the evidence for this suggestion is of moderate level (Moralejo et al., 2018). However, the majority of efforts targeted at isolation precautions focused on health care workers alone. While this was important for ensuring the lower rates of pathogen spreading, limited attention to the education of patients and visitors can limit nurses’ efforts.
In addition, when studying the ways in which healthcare facilities can improve the implementation of safety precautions for visitors and personnel, considerable variation in interventions was found. Moreover, there is a threat of bias in the certainty of the evidence, which would make it difficult to draw conclusions on the most efficient methods of safeguarding patients from the dangers of potential pathogen transfer.
In their study, Brown, Munro, and Rogers (2019) explored the use of personal protective equipment (PPE) in nursing practice. While also focused predominantly on the practice of nurses, the study included information on how protective equipment can be effectively used within healthcare settings. PPE was identified as the critical physical barrier that prevents individuals from becoming contaminated with bodily fluids, which can cause infections. Before undertaking a clinical intervention, it is recommended for nurses to use PPEs as a method of safeguarding themselves. The optimal practice of PPE use is attributed to first undertaking a risk assessment to determine the level of exposure to pathogens. Second, the PPE should fit the purpose and be suitable for the person using it.
Once a clinical intervention is complete, it is essential to remove the used PPE and dispose of it immediately and sufficiently (Brown et al., 2019). Healthcare professionals should also ensure that they avoid the contamination of surfaces, clothing, and skin. The breakdown of the measures associated with PPE use is crucial because it can be integrated into the educational pamphlet for visitors. When the latter are aware of the various PPEs that can be used in healthcare facilities, they are more likely to consider using them when entering healthcare facilities. Protective equipment is useful to have in general, and educating the public about its use can be of great advantage.
Conclusion
The review of literature encompassed studies on the importance of isolation precautions at healthcare facilities. At this time, there is limited research that would study the effects of education of patients and hospital visitors on isolation precautions. However, evidence points to the fact that increasing the awareness of the public on isolation precautions may have a good influence on the adherence to the recommended measures. Involving patients, their families, and hospital visors into a discussion on how they can prevent the spreading of pathogens within healthcare facilities is imperative. Research shows that when patients are engaged in collaboration with their nurses on adherence with hygiene measures, both target groups are more likely to adhere to both general and pathogen-specific precaution recommendations.
It should also be mentioned that most research targets nurse practitioners as the key target audience for education on isolation precautions. Both standard and transmission-based precautions are steps that are recommended for healthcare personnel to implement when dealing with different groups of patients. However, such precautions do not consider the role of hospital visitors in contributing to the risks of potential pathogens. The proposal for creating a pamphlet that would educate visitors on relevant isolation precautions is based on the fact that current studies underline the importance of such education but rarely include the perspectives of visitors. When the general public is aware of the simple but effective isolation precautions they can implement to limit their impact on healthcare environments, they are expected to have a positive impact on such settings.
Summary
The review of literature on the subject of safety and isolation precautions showed that there is not enough evidence to identify effective strategies and interventions. Since there is considerable variation in the methods used in different healthcare facilities, there is a need to develop a cohesive and straightforward solution that can be widely used in hospitals. The support from visual materials is essential because they are easily accessible to a broad target audience. The creation of an informational pamphlet is vital because the method is not complicated in its implementation and is not expensive. Moreover, there is the potential of conducting a future qualitative study to evaluate the perceptions of nurses and visitors regarding the use of pamphlets.
References
Brown, L., Munro, J., & Rogers, S. (2019). Use of personal protective equipment in nursing practice. Nursing Standard, 34(5), 59-66.
CDC. (2015). Guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. Web.
Clean hands safe hands [Image] (n.d.). Web.
Görig, T., Dittmann, K., Kramer, A., Heidecke, C-D., Diedrich, S., & Hübner, N-O. (2019). Active involvement of patients and relatives improves subjective adherence to hygienic measures, especially selfreported hand hygiene: Results of the AHOI pilot study. Antimicrobial Resistance and Infection Control, 8, 1-9.
Moralejo, D., El Dib, R., Prata, R., Barretti, P., & Corrêa, O. (2018). Improving adherence to Standard Precautions for the control of health care-associated infections (review). Cochrane Database of Systematic Reviews, 2, 1-58.
Munoz-Price, S., Banach, D., Bearman, G., Gould, J., Leekha, S., Morgan, D., Palmore, T., … Wiemken, T. (2015). Isolation precautions for visitors. Infection Control and Hospital Epidemiology, 36(7), 747-758.
Siegel, J., Rhinehart, E., Jackson, M., Chiarello, L., & the Healthcare Infection Control Practices Advisory Committee. (2019). 2007 guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. Web.
Stockowski, L. (2016). Hospital visitors and isolation precautions: Clearing up the confusion. Web.
Wolfensberger, A., Anagnostopoulos, A., Clack, L., Meier, M-T., Kuster, S., & Sax, H. (2019). Effectiveness of an edutainment video teaching standard precautions – a randomized controlled evaluation study. Antimicrobial Resistance and Infection Control, 8, 82-92.