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. 2019 Oct 9;8(4):e000663.
doi: 10.1136/bmjoq-2019-000663. eCollection 2019.

Prevention of respiratory outbreaks in the rehabilitation setting

Carla Corpus  1 , Victoria Williams  1 , Natasha Salt  1 , Tanya Agnihotri  1 , Wendy Morgan  1 , Lawrence Robinson  1   2 , Lorraine Maze Dit Mieusement  1 , Sonja Cobbam  1 , Jerome A Leis  1   3
Affiliations

Prevention of respiratory outbreaks in the rehabilitation setting

Carla Corpus et al. BMJ Open Qual. .

Abstract

Background: Respiratory viral (RV) outbreaks in rehabilitation facilities can jeopardise patient safety, interfere with patient rehabilitation goals and cause unit closures that impede patient flow in referring facilities.

Problem: Despite education about infection prevention practices, frequent RV outbreaks were declared each year at our rehabilitation facility.

Methods: Before and after study design. The primary outcome was the number of bed closure days due to outbreak per overall bed days. Process measures included delays in initiation of transmission-based precautions, RV testing and reporting of staff to occupational health and safety (OHS). Balancing measures included the number of isolation days and staff missed work hours.

Interventions: Based on comprehensive analysis of prior outbreaks, the following changes were implemented: (1) clear criteria for initiation of transmission-based precautions, (2) communication to visitors to avoid visitation if infectious symptoms were present, (3) exemption of staff absences if documented due to infectious illness, (4) development of an electronic programme providing guidance to staff about whether they should be excluded from work due to infectious illness.

Results: The number of bed closure days due to outbreak per overall bed days dropped from 2.8% to 0.5% during the intervention season and sustained at 0.6% during the postintervention season (p<0.001). There were fewer delays 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) and fewer isolation days (7.8% vs 7.3%; p=0.02) without a significant increase in missed work hours per 100 hours worked (4.0 vs 3.9; p=0.12).

Conclusion: This Quality Improvement study highlights the process changes that can prevent respiratory outbreaks in the rehabilitation setting.

Keywords: infection prevention; quality improvement; rehabilitation medicine; respiratory outbreaks.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Monthly proportion of patients initiated on droplet and contact precautions greater than 24 hours from symptom onset.
Figure 2
Figure 2
Monthly proportion of patients undergoing respiratory viral testing greater than 24 hours from symptom onset.
See this image and copyright information in PMC

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