January 12, 2007

Contact Precautions Plus: Changes
in policy

In September 2005, the MGH Infection Control Unit introduced a new category of isolation precautions known as "Contact Precautions Plus" for patients with Clostridium difficile-associated diarrhea. This category differed from Contact Precautions in that it required all staff to wash and dry their hands after contact with the patient or the patient's environment before using Cal Stat. Contact Precautions Plus also involved a special cleaning process called the "drench method" using the hospital-approved disinfectant Virex. These interventions, however, have not reduced the rates of health care-associated C. difficile-associated infection during the past year. As a result, the MGH Infection Control Unit recently made a change to the cleaning component of the Contact Precautions Plus policy.

Staff now will use a bleach-based detergent/disinfectant product made by Clorox for routine cleaning of inpatient rooms of patients on Contact Precautions Plus for C. difficile-associated diarrhea. Unit-based education has been provided to nurses and unit service associates (USAs) about this product, which recently was rolled out in these areas. The Contact Precautions Plus sign posted outside of patient rooms also has been redesigned with the word "Plus" in larger text and highlighted in red. This sign will signal to USAs that the room should be cleaned with the new Clorox detergent/disinfectant.

The full policy for Contact Precautions Plus is available on the Infection Control Unit website at infectioncontrol.massgeneral.org/icu/. Contact Precautions Plus signs may be ordered from Standard Register (#84636). For more information about precautions for C. difficile-associated diarrhea, call (617) 726-2036.