97 - Assessment of Personal Protective Equipment Adherence in Red Box Using Remote Video Auditing

Background: “Red box (RB)” is a delineated space in the entry way to a patient(pt) room(rm) that facilitates communication between pt and health care provider (HCP) without the latter needing to don/doff personal protective equipment (PPE). It decreases PPE use where unnecessary and increases pt satisfaction ratings. Remote Video Auditing (RVA) is a novel technique used to ensure adherence to isolation precautions. In this study, we used RVA to compare HCP compliance rates with PPE use in isolation rms with or without RB.                             

Methods: A prospective observational study (2/26/19-2/27/20) was designed to evaluate HCP compliance with PPE when entering or exiting droplet/contact isolation rms. RB was demarcated by red tape as a 3-ft area at rm entrance, >6 ft from the head of the bed. Cameras were placed at the entry of 4 rms with RB (RB rms) and 2 isolation rms without RB (control rms). Adherence to gowns, gloves, masks and hand hygiene (HH) was reviewed by trained independent remote observers to maintain uniformity. When HCPs stayed in the RB, compliance at exit was calculated. Compliance was compared between events of HCPs going beyond the RB and those of HCPs entering/exiting control rms using binomial regression models with log link.

Results: RVA captured 6959 pt encounters in 6 rms over a year. Consistent with RB protocol, when HCPs utilized the RB, 69.9% did not practice HH, 91.6% did not utilize gloves and 95.2% did not use gowns (Table 1). When HCPs went beyond the RB, there was significantly increased non-compliance with PPE and HH in RB rms compared with control rms (Table 2). Healthcare-associated infection (HAI) rates for this unit assessed using NHSN criteria demonstrated no increase as compared to prior years.Table 1: Non-Compliance among those who entered Red Box but did not go into the room fully
Table 2: Comparison of non-compliance between group that went beyond Red Box Vs. Control group without Red Box


Conclusion: RVA, a novel, labor-efficient and objective method, was used for observing and comparing PPE compliance in RB rms. Consistent with the purpose of RB, >90% HCPs did not use PPE while confined within it. However, HCPs going beyond the RB were more non-compliant with PPE use as compared to HCPs in control rms. While HAI rates were not increased, this finding is concerning – HCPs going beyond RB may not have used PPE (even in close proximity) due to a false sense of security due to RB. Re-education about optimal use of the RB or discontinuing RB should be considered.
 

Presenting Author(s)

• 

  Vansha Singh, MBBS, MD

  MD
  Northshore University Hospital, Northwell health
  Manhasset, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

  Slides Slides and Audio

Co-Author(s)

• AK

  Akshay Khatri, MBBS

  Fellow
  Donald and Barbara Zucker School of Medicine
  Manhasset, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• AK

  Aradhana Khameraj, RN, MSN, CIC

  RN
  Northshore University Hospital Northwell Health
  Manhasset, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• RR

  Rehana Rasul, MA MPH

  Biostatistician
  Feinstein Institute of Medical Research Northwell Health
  Manhasset, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• RS

  Rebecca Schwartz, Ph.D

  Associate Professor
  Northwell Health
  Manhasset, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• PM

  Prashant Malhotra, MD

  Associate Professor
  Northshore University Hospital, Northwell Health
  Manhasset, New York

  Disclosure: Gilead Sciences Inc.: Scientific Research Study Investigator
• BF

  Bruce Farber, MD, FIDSA, FACP

  Physician, Chief of Department of Infectious Disease
  Northshore University Hospital Northwell Health
  Manhasset, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.