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J Hosp Infect. 2018 Sep;100(1):70-75. doi: 10.1016/j.jhin.2018.01.001. Epub 2018 Jan 6.

Adherence to contact precautions by different types of healthcare workers through video monitoring in a tertiary hospital.

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Disease Control and Prevention Centre, National Centre for Global Health and Medicine, Tokyo, Japan. Electronic address:
Disease Control and Prevention Centre, National Centre for Global Health and Medicine, Tokyo, Japan.
Infection Control and Prevention, National Centre for Global Health and Medicine, Tokyo, Japan.



Contact precautions are required to prevent transmission of multi-drug-resistant organisms; however, reports on adherence rates vary. This study used video monitoring to evaluate adherence to the use of personal protective equipment (PPE) by different types of healthcare workers.


This observational study was conducted in a 781-bed tertiary hospital from July 2016 to March 2017. Cameras were installed in areas where staff don PPE. Infection control teams observed the videos and assessed adherence rates.


In total, 1097 opportunities for donning PPE were observed. Most staff observed were nurses and nursing assistants (Ns/Nsas) (880/1097, 80.2%). Overall, the adherence rate to appropriate PPE use was 34.0%. The adherence rate among Ns/Nsas was lower (239/858, 27.9%) compared with infectious disease doctors (18/18, 100%) and cleaning staff (42/49, 85.7%). The adherence rate for PPE use for Clostridium difficile infection (CDI) with toxin detection was significantly higher than that for CDI without toxin detection and multi-drug-resistant organisms (P<0.001 for both). The adherence rate for patients with an independent functional status was higher than that for patients with a dependent functional status (P=0.018). The adherence rate was lower in the intensive care unit (ICU) than in non-ICU wards (27.6% vs 36.5%; P=0.006).


Video monitoring is a useful tool for monitoring adherence to PPE use, facilitating observation of more PPE opportunities than direct observation. Adherence to contact precautions varied by occupation; however, overall adherence was insufficient. The lower adherence rate in nurses might be due to more frequent care visits.


Adherence; Contact precautions; Multi-drug-resistant organisms; Personal protective equipment; Video monitoring

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