A SURVEY ON THE AWARENESS OF PATIENTS, VISITORS AND COMPANIONS ABOUT ISOLATION PRECAUTIONS

Nabeela AL-Abdullah 1 BSc, MSc,PhD, Bashayr GS Alamri 2 , Abeer MR Daghistani 2 , Elaf SM Altwairqi 2 , MarwahHMHakami 2 , Abaad A AL Mutairi 2 , GhadiD Mashat 2 , Wajd A Alotaibi 2 , Amal AZahrani 2 , Raneen M Abousaadah 2 , HadeelM Khoj 2 , ElafAAlrehaili 2 , Rehab AAlshamrani 2 , Ebtisam MF Alhawsawi 2 , Hawazin A Fallatah 2 and NedaaFA Alyami 2 . 1. Assistant professor and clinical epidemiology consultant. Department of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia. 2. Medical intern,Kingabdulaziz University, Jeddah ,Saudi Arabia. ...................................................................................................................... ManuscriptInfo Abstract ......................... ........................................................................ Manuscript History

1122 resistant Staphylococcus aureus (MRSA) infections occur annually. It is the most common complication of acute hospitalization and it might be the leading cause of human death 3,4 . In order to decrease and prevent the incidence of infectious diseases and transfer from person to person , there is need for teaching patients' visitors and families about isolation global cautions and showing them how to use personal protective equipment (PPE) in appropriate way as used by health providers These precautions be adhered strongly in the cases of drug-resistant Gram-negative bacteria and enteric pathogens with diarrhea . 1 The Center for Disease Control and Prevention recommends the use of isolation precautions for HCW. The guidelines mentioned that visitors who are in close contact with the patients may transmit infection to other patients 5 .Oneof the simplest measures in preventing nosocomial infections is hand hygiene 9 . Moreover, promotion of hand hygiene is considered a major challenge in infection control 6,7 .
In Thailand study , the authors reported lower level of commitments among health providers & patients' visitors towards hand-hygiene prior touching patients. The main three reasons for lack of commitments : primacy of patients' needs , oblivion and irritation of skin. 8 On the other hand, the importance of airborne isolation awareness for example is required due to the increment of incidence of tuberculosis in Saudi Arabia particularly 9.
The aim of this study is to assess the knowledge of patients" families/ visitors about a patient"s isolation status.

Method:-
The research project was done in November 2015, based on a cross-sectional study. The sample of this study is a random sample. It was collected from different units at King Abdul Aziz University Hospital (KAUH) between 1 and 5 November. The involved units were: isolation, medical, surgical and pediatrics, both male and female. The questionnaire was designed in Arabic form and divided into 4 parts: patient information (e.g. patient diagnosis, transfer from another department or another hospital), visitor information (e.g. age -sex-nationality -education level), visitorinformation about isolation (e.g. awareness, types of isolation and their precautions), visitorbehavior with isolated patients (e.g. are they willing to comply or not if they know about isolation). The questionnaire was reviewed by our supervisor, validity confirmation done and data collection took place.

Results:-
During the study period, there were 52 responses, of which 58% companions and 42% visitors and the majorityof them were aged less than 60. The majority98% spoke Arabic language,11% were not educated, 23% had been in elementary school and the remaindershave attended intermediate school and above. From 52 participants only 24 (46.2%) knew about isolation , in non-isolation units 71.8% of visitors did not know if her/his patient was isolated and the other 28.2% reported knowing about isolation from either a doctor or a nurse, while all the 13 (100%) visitors to isolation units know about it with significant difference (p<0.0001). (figs1& 2). Among the 24 responsesthere was a variety in reporting isolation signs (Fig 3),half of them 50% reported infectious diseases as reason for isolation and 33.3% stated bacterial organism . (Fig 4) Concerning Type of isolation and better ways of prevention , 29.2% stated contact and airborne equally as types of isolation and 50.2% chose mask as preventing way.

Discussion:-
Based on the current results from 52 responses; 73% of them were female, 98% less than 60 years old and 88% were educated. The survey shows substantial variation in the awareness of visitors whether patients were in isolation unit or not. More than the half of visitors did not know if her/his patient was isolated and all of them were from nonisolation units, the visitors of non-isolation were asked if they know the reason for isolation and 23% said "yes". In contrast a survey done in West Virginia University (among contact isolation patients only) with 36 participants showed that 92% of visitors knew why their patients were in isolation 1 . In the current our study, regarding the questions of how did they know about isolation the majority (54.5%) reported that they heard about the isolation status from staff, (31.8%) from isolation signs, and (13.6%) from patients. 50% of the visitors who know the reason said it was an infectious cause, (36.4%) said it had an immunodeficiency cause, and (13.6%) did not know the cause. The adherence of visitors to PPE when they knew that their patients were in isolation was 96%. Several studies demonstrate that visitors" adherence to PPE varied from "very low" to 97% 10 . One of the studies was conducted in two physically connected tertiary care hospitals among 288 participants and demonstrated that the most common cause of low compliance with contact isolation precautions is poor hand hygiene before entering the room 11  For decades , there was a global warning indicate the need for avoiding any direct contact with patients' secretions by wearing gloves goggles, and using Medical masks to protect nose, mouth and eyes , in 1987 these global precautions were modified and organized among a group of rules named "body substance isolation". In1996 all these cautions were substituted by standard& advanced cautions , and regarding these new cautions all the literature reviews now recommend the using of PPE in all health facilities. 5 There are many limitations in current study. The time was limited, the sample size was small, the ICUs visitors were not included in the study and the study was conducted in one hospital; all of which make it difficult to generalize the findings.

Conclusions:-
This study focused on the importance of communication with patients" visitors. The majority of visitors and companions did not know about their patient"s isolation and the reason for it. One of the causes was that the information was written in the English language only. The isolation unit visitors and companions were more educated about isolation and its precautions while non-isolation units" visitors were less educated. Thus, the authors recommend that all visitors regardless of their patient's unit should be educated about the need for isolation. The level of education of visitors and companions plays an important role in their awareness of their right to know about patients" safety. Hence, we recommend that educational material for all population levels should be presented in simple language.