Assessing patient and caregiver understanding of and satisfaction with the use of contact isolation.

BACKGROUND: Contact isolation is a method used for limiting the spread of antimicrobial-resistant organisms when caring for patients. This policy has been linked to several adverse outcomes and less patient satisfaction. We assessed patient and caregiver understanding and satisfaction with the use of contact isolation. METHODS: A prospective survey of >500 patients in contact isolation at our institution was performed during 2014. Participants responded to a series of statements relating to contact isolation, using a 5-point Likert scale. Responses were assessed for overall positivity or negativity and further compared according to floor type or designation. RESULTS: Of the patients, 48.7% responded to the survey; 70 caregivers also responded. Patient and caregiver responses were similar and were positive overall. Most respondents felt safer because of the use of contact isolation and because it prevented infections. A smaller majority of respondents also thought the policy was adequately explained to them and adhered to by staff. CONCLUSIONS: In the largest collection of respondents surveyed to date about contact isolation and its impact on them, the policy was viewed positively, both by patients and caregivers. There is still room for improvement in the area of patient education regarding the use of contact isolation.

Group session teaching of behavioral modification program (BMP) for urinary incontinence: a randomized controlled trial among incontinent women.

PURPOSE: To determine effectiveness of Group BMP in managing female urinary incontinence (UI), using a standardized protocol taught to adult incontinent women. MATERIALS AND METHODS: Forty-four adult women with slight to severe UI had baseline parameters collected (UI questionnaires, 3-day voiding diary, pelvic floor muscle strength testing, 24-h pad test, and cough stress test) and were randomized to a control group (CG) with no treatment and a treatment group (TG) who underwent a single group session lecture by two trained urology nurses on BMP followed 2-4 weeks later with individualized assessment of knowledge acquired and reinforcements if needed. The same baseline measures were collected after 6-8 weeks, and statistical analysis comparing changes within groups and between CG and TG were performed. RESULTS: Baseline data for both groups showed no statistically significant difference except for an age difference. At 6-8 weeks post-intervention, a statistically significant higher proportion of the TG (52.2%) improved when compared to the CG (16.7%). Also, the TG showed statistically significant improvement in 24-h voids, reduced leak diameter on cough test, improved pelvic muscle strength in pressure score, displacement, and duration, respectively, compared to their baseline pre-intervention data. The CG had only a statistically significant change for displacement score. CONCLUSIONS: Group session teaching of BMP by trained urology nurses reduces UI severity, increases pelvic floor muscle strength, and reduces voiding frequency. This pilot study may precede establishment of single session Group BMP as both preventive and therapeutic for a cost-effective broad-based program in the future.

Prevention of urinary incontinence by behavioral modification program: a randomized, controlled trial among older women in the community.

PURPOSE: We determined whether a behavioral modification program (BMP) taught to groups of continent older women would decrease the incidence of urinary incontinence, increase pelvic muscle strength and improve voiding control. MATERIALS AND METHODS: We performed a randomized, controlled trial comparing a BMP treatment group to a control, no treatment group in ambulatory, postmenopausal, continent women (0 to 5 days of incontinent episodes in the previous year) 55 years and older who were followed for 12 months. Qualified volunteers from 4 Michigan counties were randomly assigned to a control or a treatment group, consisting of a 2-hour classroom presentation on BMP followed 2 to 4 weeks later with individualized evaluation to test knowledge, adherence and skills in behavioral techniques, and brief reinforcement of the technique as needed. Followup was done by telephone and mail every 3 months except month 12, when all participants underwent final clinical evaluation. Outcome measures were continence status, pelvic floor muscle strength and voiding frequency/intervoid interval. RESULTS: A total of 195 control and 164 treated participants completed the study. Baseline data on the 2 groups were not statistically different. At 12 months the treatment group was statistically significantly better than the control group in continence status (p = 0.01), pelvic muscle strength (pressure score p = 0.0003 and displacement score p <0.0001), improved voiding frequency (p <0.0001) and intervoid interval (p <0.0001). CONCLUSIONS: To our knowledge we report the first randomized, controlled trial of BMP for preventing urinary incontinence in older women. It demonstrated feasibility and efficacy in improving continence status, pelvic muscle strength and voiding control as long as a year after treatment.