LOS ANGELES — Physicians were the least likely among health care workers to comply with hospital rules requiring isolation gowns in rooms of patients carrying multiresistant organisms, according to a study aimed at exploring ways to reduce severe nosocomial infection outbreaks.
Among physicians, surgeons were the least compliant, reported Farrin A. Manian, M.D., an infectious disease specialist at St. John's Mercy Medical Center in St. Louis, at the annual meeting of the Society for Healthcare Epidemiology of America.
Gowns and gloves are required as part of modified contact precautions (MCP) at Dr. Manian's hospital as part of an effort to avert the epidemic spread of infections caused by organisms such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and Clostridium difficile.
All visitors and health care workers must comply with precautions before entering the well-marked rooms of patients infected or colonized by these pathogens.
But just 74% of 2,144 people seen entering MCP rooms wore gowns in a covert observation study coordinated by Dr. Manian and John J. Ponzillo, Pharm.D., at the 900-bed tertiary care medical center.
Health care workers were more likely than visitors to wear gowns, at rates of 77% and 66%, respectively.
The health care workers most likely to comply were respiratory therapists, with a compliance rate of 96.2%. Physicians were the worst at following infection control gown orders, with a compliance rate just over 67%.
Compliance also varied by medical specialty, with intensivists topping the list at a compliance rate of 84%, followed by house staff, 71%, miscellaneous physicians, 70%, internists and family physicians, 61%, and surgeons, 41%.
Logistic regression analysis identified three factors independently associated with noncompliance with the gown rule: location of the patient room in a non-ICU ward, occupation (physician), and male gender.
There was a very strong correlation between gown use and glove use among health care workers in the ICU, with 110 of 115 workers (96%) wearing gowns also wearing gloves, compared with 3 of 18 (17%) not wearing gowns.
Dr. Manian stressed the importance of complying with modified isolation precautions in hospital environments increasingly under threat of difficult-to-control nosocomial infections.
In an interview about poor physician compliance, he said, “Honestly, I think it has to do with the perception of risk. If I said this patient has Ebola, physicians would comply.”
Some physicians, he added, “think rules don't apply to them.”
