Evaluation of Compliance in Control and Prevention Study of Vancomycin Resistant Enterococcus Outbreak

Table 1

Scoring Form for Fight against VRE.

(i) Placing the patient in the room (10 points total)	Score
(1) Patient colonized or infected with VRE is preferably placed in an isolated room with own toilet and sink. If no isolated room is available, s/he will be placed in a room with other patients colonized with VRE.
(2) Personnel responsible for the care of the patient(s) colonized/infected with VRE are responsible for care of only this/these patient(s).
(3) Patient files and charts are outside the patient’s room.
(4) A toilet in the common bathroom is spared for this/these patient(s) and is cleaned with a 500 ppm sodium hypochlorite solution after each use.
(5) If personnel remove the stool of the patients in rooms with no toilet, the personnel wear a long gown and gloves and wash hands after removal.
(ii) Use of gloves and hand disinfection (10 points total)	Score
(1) While entering the patient room, clean and nonsterile gloves are worn before any contact with the patient or the surrounding surfaces.
(2) Gloves are changed after procedures that can cause contamination during patient care (contact with stool, infected wound drainage).
(3) Gloves are taken off before leaving the patient room.
(4) After the gloves are removed, hands are washed with an antimicrobial agent (chlorhexidine).
(5) Hands are cleaned with an alcohol-based hand disinfectant if no visible contamination with bodily fluids such as blood, feces, and so forth has occurred.
(iii) Use of gowns (4 points total)	Score
(1) Clean, nonsterile gowns are worn before entering the patient room and are taken off before leaving the room.
(2) If there is a possibility of contact with blood and other bodily fluids, a plastic gown is worn over.
(iv) Medical devices (6 points total)	Score
(1) All medical devices used are patient specific (stethoscope, sphygmomanometer, thermometers, sliders, etc.).
(2) If common use is necessary, these devices are cleaned and disinfected before use on other patients.
(3) Noncritical devices are stored in the patient room in small amounts (e.g., bandages).
(v) Surveillance monitoring (14 points total)	Score
(1) Rectal swab and stool samples are obtained from all patients in the same unit with the new cases diagnosed with VRE.
(2) Close contact isolation precautions are attained for cases with VRE detected in culture results.
(3) Weekly surveillance cultures are obtained from VRE positive patients.
(4) Close contact isolation is terminated if three consecutive weekly surveillance cultures return negative.
(5) Isolation termination decisions are made with HICC on patient by patient basis.
(6) All room surfaces are disinfected upon discharge and environmental cultures are obtained from the room.
(7) No new patients are placed in these rooms and it is prevented to use these devices on other patients until environmental culture results are obtained.
(vi) Physician visit/patient visit/attendant (10 points total)	Score
(1) Only personnel on duty work on the isolated grounds outside the visits. Unless necessary, personnel access from other areas is limited.
(2) Only personnel on duty work on the isolated grounds during night shifts outside the visits. Unless necessary, personnel access from other areas is limited.
(3) Access to and from the patient(s) room is limited.
(4) Patient attendants are informed about and trained on the matter.
(5) Visitors can see the patients within short time upon abiding by the rules.
(vii) Transportation of patients and helping them leave the room (12 points total)	Score
(1) Patients leave their rooms for as little as possible.
(2) Patients can leave the room if they do not have a wound or a lesion.
(3) Patients wash their hands with chlorhexidine before leaving their room and can wander in the corridor or on the balcony.
(4) If the patient has to leave the room, his/her destination is informed and necessary precautions are taken.
(5) If the patient is carried with a wheelchair or a stretcher, these tools are covered with a clean cover, which is removed and put into a special laundry bag after use. These tools are thoroughly cleaned with alcohol after use.
(6) If the patient’s general condition is better, he/she is informed about his/her condition and what he/she should do.
(viii) Cleanliness of the patient room (during stay) (12 points total)	Score
(1) Cleaning equipment (buckets, cloths, mops, mop handles, etc.) for the patient room is specific to the room and cannot be used in other rooms.
(2) Floors are mopped with detergent water twice and as they get dirty during each shift.
(3) The mops are disinfected after each use with 1% sodium hypochlorite water.
(4) The furniture, bedding, serum hangers, patient transfer vehicles, and so forth in the patient room are disinfected with 1% sodium hypochlorite water after cleaning.
(5) The floor and surfaces are not left wet.
(6) If the floor or the surfaces become contaminated with organic substances (blood, urine, stool, etc.), it is absorbed fully with a paper towel with gloves on and disinfected with 10% sodium hypochlorite water. It is left as it is for 10 minutes and then recleaned with warm detergent water and dried.
(ix) Terminal disinfection/cleaning (after patient is discharged) (10 points total)	Score
(1) Room and patient equipments are cleaned first with detergent and warm water.
(2) Next, they are disinfected with 1% sodium hypochlorite solution.
(3) All surfaces: walls, bathroom, toilets, doors and door knobs, the whole bed, telephone, television, monitor, call bells, and so forth with possible contamination are cleaned.
(4) Curtains and all furniture with cloth are changed and washed.
(5) All surfaces, after wiping with the disinfectant, are rinsed with water and dried.
(x) Cleaning and disinfection of devices used for patients with VRE (16 points total)	Score
(1) Patient beds are covered with a protector. The protector is cleaned after patient is discharged, and disinfected with a 70% alcohol or 1% sodium hypochlorite solution.
(2) Patient linens are placed in a waterproof bag with slow movements to avoid spread of pathogens into the air, sealed, and sent to the laundry.
(3) If the outer surface of the laundry bag is contaminated, a second bag is used.
(4) Slides and ducks are soaked in 1% hypochlorite solution for 20 minutes and drained upon discharge.
(5) Thermometers are disinfected in a 20% alcohol solution.
(6) Stethoscope is wiped with a 70% alcohol solution upon discharge.
(7) Sphygmomanometer’s metal and inner rubber parts are removed and wiped with a 70% alcohol solution. Its case is soaked either in a 10% lanyard or 1-2% sodium hypochlorite water and then rinsed.
(8) All of the materials from VRE patients are medical waste (e.g., food bag, water bottle, coke can, etc.). All of them are disposed into the red bin as long as the patient is isolated.
(xi) Patient discharge (12 points total)	Score
(1) Colonized or infected patients’ data are systematically recorded in his/her patient file.
(2) The patient is discharged as soon as possible if his/her conditions allow.
(3) If the patient is rehospitalized at the same hospital, s/he will be under close contact isolation until a negative surveillance VRE culture is obtained.
(4) While transferring a patient to another health institution, the head offices are informed about the matter.
(5) Ambulance used on patient transfer is warned to take the necessary precautions.
(6) If a patient is transferred from another hospital and has the risk factors mentioned above s/he will be under close contact isolation until a negative surveillance VRE culture is obtained.
(xii) Compliance with action plan (20 points total)	Score
(1) Faculty members
(2) Residents
(3) Interns
(4) Other consultants
(5) 4-5 year student
(6) Nurses
(7) Cleaning personnel
(8) Other personnel
(9) Patient attendants
(10) Patients
Total
Fill out the empty box next to the performed task as yes = 2, no = 0, and sometimes = 1.