Infection Prevention and Control (CAMCAH / Critical Access Hospitals)
Q. Do Joint Commission surveyors expect healthcare workers to wear a gown whenever entering the room of a patient on contact precautions?
Contact precautions: Do gowns need to be worn whenever entering the room?
Current | February 18, 2010
A. Joint Commission standard IC.01.05.01 EP 1 states: “When developing infection prevention and control activities, the organization uses evidence-based national guidelines or, in the absence of such guidelines, expert consensus.” The guideline that addresses contact precautions is published by the CDC’s Healthcare Infection Control Practice Advisory Committee (HICPAC).
Recommendation V.B.3.b.i. from the HICPAC guideline states, “Wear a gown whenever anticipating that clothing will have direct contact with the patient or potentially contaminated environmental surfaces or equipment in close proximity to the patient. Don gown upon entry into the room or cubicle. Remove gown and observe hand hygiene before leaving the patient-care environment.”
Joint Commission surveyors will expect healthcare workers to wear a gown if their “clothing will have direct contact with the patient or potentially contaminated environmental surfaces or equipment in close proximity to the patient”. The difficulty lies in “anticipating” when this may occur. For example, it is very probable that a nurses’ aide preparing to perform a bed bath will have contact as described above, and therefore a gown would be expected. However, one of a large group of residents performing rounds with an attending physician would have a lower likelihood of clothing contamination.
Each organization may decide what guidance to provide to its healthcare workers within the parameters provided by HICPAC. However, The Joint Commission would encourage organizations to consider the high morbidity and mortality of healthcare-associated infections in our nation when deciding what constitutes “anticipated contact” in each facility. Additionally, organizations may want to discourage non-essential personnel from entering the rooms of patients on isolation precautions.