ICP Guide on Monitoring Compliance With Contact

Isolations
Definition: The percentage of compliance by health care workers with all components of
contact precautions for patients infected or colonized with organisms that
require these precautions.

Goal : 100% of encounters in full compliance

Definition of Terms:
Complete compliance is defined by the adherence to the Centers for Disease Control and
Prevention (CDC) Contact Precautions.

Location / Timing Contact Precaution Requirement

1-Prior to entering patient
room
2-While in patient room
3-Prior to exiting patient
room
Health care worker (HCW) dons gloves and gown
During the course of providing care for a patient, HCW
changes gloves after having contact with infective
material that may contain high concentrations of
microorganisms (fecal material and wound drainage)
and between tasks/procedures on the same patient
HCW removes gloves before leaving the patient's room
and cleanse hands immediately with an antimicrobial
agent or a waterless antiseptic agent AND removes
gown. After glove removal, handwashing, and gown
removal, HCW ensures that hands and clothing do not
touch potentially contaminated environmental surfaces
or items in the patient's room to avoid transfer of
microorganisms to other patients or environments.

CALCULATION DETAILS:
Numerator Definition :Total number of times where HCWs were observed compliant with
the contact precautions.
Denominator Definition: Total number of times where HCWs were observed having contacts
with patients under contact precautions.(Opportunities)

Measurement Period Length: When deemed necessary (for one month at least twice a week
for 20 minutes each session)

Calculate as: (numerator / denominator) x 100; as a percent

Collection Form& Calculation Form once completed should be forwarded to the biostatistician
and Infection control director within the first 3 working days of the next month for review and
final report would be forward it to the respective area.
 ICP Guide on Monitoring Compliance With Contact
Isolations
Collection Form
Area: _____________
Collector ID (Badge):_______________________Month:_______Year:______.
Healthcare Worker (HCW) Instructions on filling this form:
categories: 1- Complete the details at the top of the form
1 = Physicians 2- Find a convenient place to observe the contact isolation rooms without disturbing care
2 = nurses activities; you can move to follow the health-care workers, but never interfere with their
3 = respiratory therapy work. However, you can provide feedback after the session.
4 = PT/OT 3- Use the category codes on the right and fill accordingly
5 = housekeeping 4- Put an (O) whenever the person is entering the room and there is an opportunity to
6 = dietary perform these steps.
7= visitors/sitters 5- Beside that (O) put a (C) for his/her compliance with the required steps if the steps were
performed; if they were not performed just leave it blank.

Healthcare Worker (HCW) categories

1 2 3 4 5 6 7
Before entering the room:
HAND HYGIENE

Before entering the room:

Gown:
Opening is in the back, Secure at neck
and waist

Gloves
Extend over gown cuffs

While in patient room

HCW changes gloves after having contact with
infective material that may contain high
concentrations of microorganisms (fecal
material and wound drainage) and between
tasks/procedures on the same patient

Prior to exiting patient room:

Gloves Removed

Prior to exiting patient room:

Remove Gown

Outside the patient room:

HAND HYGIENE.
If hand hygiene was performed inside the
room and nothing was touched afterward,
it would be considered compliant
I.E. ICUs.
 ICP Guide on Monitoring Compliance With Contact
Isolations
Calculation Form
Healthcare Worker (HCW) categories
1 2 3 4 5 6 7 Compliance
O C O C O C O C O C O C O C all Os all Cs Compliance
Rate
C/O*100
Before entering the room:
HAND HYGIENE

Before entering the room:

Gown:
Opening is in the back, Secure
at neck and waist
Gloves
Extend over gown cuffs
While in patient room
HCW changes gloves after having
contact with infective material that
may contain high concentrations of
microorganisms (fecal material and
wound drainage) and between
tasks/procedures on the same
patient
Prior to exiting patient
room:
Gloves Removed

Prior to exiting patient

room:
Remove Gown

Outside the patient room:

HAND HYGIENE.

all Os
all Cs
Compliance Rate
C/O*100