Running Head: PICOT STATEMENT 1
PICOT Statement Paper
Grand Canyon University: NRS-493-0501
Sometime this year
PICOT Statement Paper
For patients with a private room within the Emergency Department (P), will the use of privacy door blinds (I), compared to those that utilize privacy room curtains (C), have decrease in cross-contaminations (O)?
The Emergency Department (ED) consists of 15 small rooms with private doors but open windows with a hanging cloth curtain providing patient privacy. The curtain hangs from the ceiling directly at the foot of the patient’s bed. This makes the curtain a high touch area as it must be frequently moved to get around the patient’s bed to provide quick and appropriate care. Bedrails, intravenous poles, sinks, bedside tables, and privacy curtains are all in the top 10 high-touch items in the healthcare setting (Cheng et al., 2015). Quick and high turn-over of the department leaves ED staff members to quickly clean the rooms prior to the next patient entering. After cleaning, one high touch item remains – the privacy curtain hanging from the rod in the ceiling. Hospital privacy curtains have statistically been known to harbor germs bacteria and viruses. Common hospital-acquired pathogens such Vancomycin Resistant Enterococcus (VRE), Methicillin resistant Staphylococcus aureus (MRSA), Escherichia Coli (E.Coli), Clostridium difficile (C-diff), influenza, and the Rota virus (Carikas & Matthews, 2019).
Several studies have been conducted to determine which type of privacy curtain will help slow and prevent growth. There have also been studies regarding how often curtains should be changed to decrease the likelihood of cross contamination. There have even been studies on who touches the curtain most often and where the curtain is most touched. At the end of each study it is concluded that all types curtains regardless of how often they were changed had a high risk of cross-contamination. It is also decided, “Ideally, curtains could be eliminated from hospitals, but for the sake of privacy and convenience, and without feasible alternatives, this seems improbable for the time being” (Brown, Siddiqui, Mcmullen, Waller, & Baer, 2020). Implementation of privacy blinds or opaque glass doors (Brown et al., 2020) would eliminate the high touch items reducing the risk of infection. Privacy blind installation would be more cost efficient than changing out the door/windows.
Privacy curtains increase the risk of infection, delay patient care, and create periods of complete patient exposure. Since the rooms are small and the curtains invade patient space, they are frequently being touched and moved by healthcare workers, patients, and family (Cheng et al., 2015). Healthcare workers continuously move the curtain (breaking hand hygiene compliance) to move around the patient and provide care on both sides (Ohl et al., 2012). Open and closing the curtain to move around often leaves the patient completely exposed for a short period of time.
Implementation of privacy curtains would be applied by engineering. Nursing wise hand hygiene compliance and utilizing appropriate patient privacy with blinds are key interventions. The primary concern with the removal of privacy curtains is maintaining patient privacy. When individual rooms are an option, utilization of the blinds would remove the element of a potential cross contamination. Nursing intervention is to provide privacy by knocking and waiting for a response prior to entering. In addition, it is important to keep doors and blinds closed unless in a situation that requires close monitoring.
Health Care Agency
Most facilities have a cleaning or changing schedule for curtains based on availability of replacements, intervals, or when visibly soiled (Woodard, Buttner, Cruz, & Roeder, 2018). The infection preventionist at this facility reports the current guidelines are for Emergency Department curtains to be replaced every 6 months or if visibly soiled. Isolation/COVID-19 rooms must be terminally cleaned by environmental services and have different style of curtains that can be sprayed/cleaned more easily than the fabric counterparts. Implementation of curtains that are able to be cleaned as easily as other high touch areas would change the current cleaning guidelines.
Currently, healthcare providers complain about the privacy curtains “being in the way” and causing a delay in care. Raising concern for the safety of our patients and creating an argument for removal of privacy curtains is key. Implementing and utilizing privacy blinds appropriately will provide more space for patient care and family involvement while decreasing the risk of cross-contamination.
Brown, L., Siddiqui, S., Mcmullen, A., Waller, J., & Baer, S. (2020). Revisiting the “leading edge” of hospital privacy curtains in the medical intensive care unit. American Journal of Infection Control. doi: 10.1016/j.ajic.2020.03.015
Carikas, K., & Matthews, S. (2019). Hospital Privacy Curtains — What’s hanging around? Dissector, 47(1), 20–22.
Cheng, V., Chau, P., Lee, W., Ho, S., Lee, D., So, S., … Yuen, K. (2015). Hand-touch contact assessment of high-touch and mutual-touch surfaces among healthcare workers, patients, and visitors. Journal of Hospital Infection, 90(3), 220–225. doi: 10.1016/j.jhin.2014.12.024
Ohl, M., Schweizer, M., Graham, M., Heilmann, K., Boyken, L., & Diekema, D. (2012). Hospital privacy curtains are frequently and rapidly contaminated with potentially pathogenic bacteria. American Journal of Infection Control, 40(10), 904-906. doi:10.1016/j.ajic.2011.12.017
Woodard, D., Buttner, M., Cruz, P., & Roeder, J. (2018). Microbial contamination of privacy curtains in the emergency department of a metropolitan hospital. Journal of Hospital Infection, 100(3). doi: 10.1016/j.jhin.2018.06.018