859 - Remote Video Auditing (RVA) To Assess Personal Protective Equipment (PPE) Compliance In Rooms With Clostridioides difficile Patients

Background: Nosocomial Clostridioides difficile (Cdiff) outbreaks can be prevented by PPE use and hand hygiene (HH) by healthcare providers (HCPs). A rise in Cdiff cases in our oncology unit prompted the use of novel educational and monitoring measures for infection control. Remote video auditing (RVA), a new technique to ensure isolation adherence, is more objective and reliable than standard direct observation. In this study, we used RVA to assess HCP compliance with PPE in Cdiff patient (pt) rooms (rms) and other rms in the same unit.

Methods: A prospective observational study (supported by the Karen Brown research fund) was conducted over 8 months. RVA involved video recording of HCP encounters at entry/exit from Cdiff pt rms and other rms in the same unit. Adherence to PPE (gowns/gloves), HH and PPE doffing sequence was reviewed by independent trained observers using a uniform protocol. Data was captured from electronic records and infection prevention data (using NHSN criteria). Data from 2 time periods [P1 (July 2019-Oct 2019), P2 (Nov 2019-Feb 2020)] and historical controls (HC) were compared for significance using students t-test.

Results: We compared PPE/HH rates in 5685 encounters in all rms in the unit to PPE/HH rates from HC and surprisingly saw lower compliance rates during the study (Table 1). We also analyzed 507 encounters in Cdiff rms (Table 2). An increased compliance with PPE (but not HH) was noted at rm entry in P2 as compared to P1, but it was not statistically significant (Table 2). There was significantly increased compliance with PPE/HH and proper doffing when exiting a pt rm in P2 as compared to P1 (Table 2). Cdiff cases per patient day decreased from P1 to P2 (0.003 to 0.001). We believe the discordant findings were due to Hawthorne effect (change in behaviors due to the awareness of being observed) and the well-known inherent unreliability of direct observation methods used for monitoring HC.Table 1: Comparison of PPE compliance rates (use of gowns, gloves, and mask) and hand hygiene for the entire unit, between the entire study period and historical control rates
Table 2: Comparison of PPE compliance rates (use of gowns, gloves, and mask), proper doffing sequence and hand hygiene at entry and exit at a Cdiff patient’s room, between two time periods [#: Doffing was recorded by RVA only at time of exit from Cdiff rooms]


Conclusion: RVA is a more reliable and less labor-intensive assessing adherence to isolation precautions than direct observation. RVA recorded increased PPE compliance over time (particularly at exit from isolation rms), resulting in reduced Cdiff infections. Thus, RVA, by ensuring strict isolation precautions, may be better than direct observation in preventing communicable infections like Cdiff.