The Red Box Strategy for Contact Precautions

Monday, 28 July 2014: 7:20 AM

Melissa A. Pollard, DNP, RN-BC, ARNP
Professional Development and Clinical Support, Exeter Hospital, Exeter, NH
Kathleen Wickens, BSN, RN, CCRN
ICU, Exeter Hospital, Exeter, NH


This work originated in a small community hospital who committed to achieving Magnet designation.  As part of this commitment, an identified need was to develop a means to promote and support nursing research in our organization which did not have any university affiliations.  Our Magnet Journey was successful, and this presentation reflects work done by one of our first direct care staff nurses with the support of the nursing research committee.

Contact precaution policy requires healthcare personnel to always put on Personal
Protective Equipment (PPE) before entering a contact precaution room. Although
instituted to prevent hospital-acquired infections (HCAIs), this process takes a
significant amount of time, causing delays that produce patient anxiety, frustration and
dissatisfaction with care. Research shows that health care workers spend less time
with patients in isolation. Contact precautions decrease the quality and frequency of
interactions provided by staff to patients and decrease compliance with precaution
policies. There is significant cost associated with the use of PPE. Previous
research has shown that contact precautions can be modified to promote interaction
between patients and care givers without increasing the risk of spreading HCAIs. A
previous study conducted by Trinity Regional Medical Center, a Magnet Hospital in
Illinois, showed that a “Safe Zone” created at the contact precaution room doorway
allowed staff to safely enter a short distance into the room without putting on PPE for
the purpose of interacting with the patient.  The objectives included to evaluate the effects of “The Red Box Strategy” for contact precautions on patient and healthcare giver satisfaction with the contact precaution process, healthcare giver compliance with personal protective equipment (PPE), and potential cost savings of personal protective equipment.


Likert Survey was performed for patient and healthcare giver satisfaction of contact
precautions before and after instituting “The Red Box Strategy”.
A Mann-Whitney test for independent samples was performed to examine the
relationship between satisfaction of the contact precaution process before and after
instituting “The Red Box Strategy”.
Data collection was performed on personal protective equipment compliance of 4
different caregiver types on hand hygiene, gowns, and gloves before and after
instituting “The Red Box Strategy”.
A Chi-Square test was performed to examine the relationship between compliance with
the contact precautions process before and after implementing “The Red Box Strategy”.
The frequency of the use of “The Red Box Strategy” by caregivers was measured and
the potential cost savings of gowns was estimated.


A statistically significant relationship was found between pre and post implementation
survey responses. Patient and healthcare giver satisfaction increased for contact
precautions after “ The Red Box Strategy was implemented.
A statistically significant relationship was found for all aspects of PPE measured for
compliance when “The Red Box Strategy” was used for contact precautions by RN’s,
LNA’s, and RT’s. A statistically significant relationship was found for hand hygiene
compliance upon entering a room for MD’s but not for hand hygiene out, gown on and
tied and gloves worn for MD type.
For all healthcare giver types hand hygiene compliance for entering a room increased
32%, hand hygiene compliance when exiting a room increased 11%, gowns on and tied
increased 16%, and gloves worn increased 4%.  Data collected for evaluating “The Red Box Strategy” affect on
potential cost savings was insufficient to analyze, so further analysis of the data is being undertaken. 


Using “The Red Box Strategy” increased patient and caregiver satisfaction with the
contact precaution process. The strategy increases compliance for many aspects of
PPE for most caregiver types. The exceptions to this were no relationship was found
between the strategy and MD compliance with hand hygiene upon room exit, gown and
gloves worn. “The Red Box Strategy” staying power demonstrated consistency with the
trial’s findings, with compliance rates holding at 6 months post implementation.